In the dystopian novel 1984, George Orwell introduced the idea that vocabulary has the power to control thought. In 1984, the government, in an effort to control citizens and force them into submission, subverts the meaning of common words and phrases to promote approved views.

This type of language manipulation is also known as “doublespeak,” as Wikipedia explains:

There’s nothing “baby friendly” about letting an infant starve.

… Doublespeak may take the form of euphemisms (e.g., “downsizing” for layoffs, “servicing the target” for bombing, making the truth less unpleasant, without denying its nature. It may also be deployed as intentional ambiguity, or reversal of meaning (for example, naming a state of war “peace”). In such cases, doublespeak disguises the nature of the truth, producing a communication bypass.

The Baby Friendly Hospital Initiative (BFHI) is an outstanding example of doublespeak. In 2016, the breastfeeding industry, in an effort to control women and force them to use their breasts in the lactivist approved manner, subverts the meaning of “baby friendly” to promote breastfeeding.

The BFHI torments mothers, muzzles doctors and nurses, and, unconscionably, it bullies babies in an effort to ensure ideological conformity.

What do I mean?

Anything that is baby friendly would take into account the needs of babies, and if babies need anything at all, they need to eat.

Hunger is probably the most elemental of infant drives and, as anyone who has seen an infant scream from hunger would probably agree, is experienced by the baby as suffering. For most mothers, myself included, the sound of their own infant crying is piercing in its intensity and distress. I remember being surprised by this when my first child was born. I had spent my entire professional life surrounded by crying babies and it had never bothered me, yet I found my son’s crying unbearable and always rushed to determine what was wrong and fix it in any way possible.

It is a biological FACT that at least 5-15% of women will not make enough breastmilk to fully nourish a growing baby. If that rate sounds high to you or incompatible with the survival of the human race, consider this: the natural rate of miscarriage of established pregnancies is 20% and we’ve survived and thrived despite a high death rate of embryos. A rate of inadequate breastmilk production of 5-15% is comparable. And that doesn’t even include those mothers whose milk comes in late.

What happened to those babies prior to the advent of infant formula? They starved to death.

Exclusive breastfeeding rates of 100%, as occurs in nature, aren’t very baby friendly at all.

Along comes the BFHI, airily ignoring the biological reality of breastfeeding, and focusing instead on ideological conformity. The BFHI is all about promoting a process. But being “baby friendly” should be about the outcome for babies, not the process. There is nothing baby friendly about letting a baby starve.

Healthy infants are equipped to survive a short period without much nutrition. That’s why most babies lose a little weight in the first two days. But after that point, a baby who isn’t receiving an adequate amount of breastmilk begins to starve. And that’s what happens to those 5-15% of babies whose mothers don’t produce enough breastmilk and the additional babies whose mothers’ milk comes in late. They starve with all the agony that implies.

When a baby continues to lose weight beyond the first few days, the baby’s body begins to digest itself. That’s what weight loss is, the baby breaking down its own cells to supply its brain, heart and other vital organs with nutrients. The baby becomes dehydrated and its sodium level begins to rise; seizures, brain damage, and death can be the result. Bilirubin, a waste product, can built up. If the bilirubin level gets high enough (kernicterus) the baby’s skin color becomes orange and permanent brain damage may occur.

That’s bad enough, but the worst part is that the baby FEELS that she is starving and she suffers. She screams from hunger until she is too exhausted or too weak to cry. She can’t sleep because hunger wakes her up to scream some more.

What’s baby friendly about that? NOTHING!

What can a woman do if she suspects that her newborn is starving? Not much, if she’s in a “baby friendly” hospital. Infant formula, which would ease the baby’s suffering and has been shown to preserve not harm the breastfeeding relationship, is off limits. A mother must subject herself to a mandatory lecture from nurses and or lactation consultants. She may need to beg for formula or send a family member out to buy it. She is the object of official scorn. All the while her baby is suffering.

Nurses and doctors are muzzled; they can’t counsel her about formula supplementation until the baby is seriously ill. All the while her baby is suffering.

We KNOW that this will happen to 5-15% of babies yet, under pressure from the breastfeeding industry, doctors and hospitals have caved to this distinctly baby unfriendly policy. Why? Not because it’s good for babies; not because it’s good for mothers; they submit because the BFHI credential is good for MARKET SHARE.

The ultimate irony? There’s no evidence that the BFHI has much if any impact on breastfeeding rates.

What should we do?

It seems to me that a good first step would be to force the program to change its name to more accurate “Breastfeeding Friendly” Hospital Initiative. Instead of hiding the true motivation in doublespeak designed to manipulate women, let’s be honest about who really benefits: lactivists and their organizations.

Let’s also make the program mother friendly by ending the hectoring lectures to mothers, ending the muzzling of doctors and nurses, making formula easily accessible, and re-opening well baby nurseries so new mothers can rest and heal from childbirth.

Most importantly, let’s make babies’ wellbeing the centerpiece of hospital care by ending the mandatory starvation the agony that goes with it for a substantial proportion of babies.

There’s nothing baby friendly about letting an infant scream in hunger. The BFHI makes babies suffer. That MUST stop.

You say that infant formula is “off limits” in a BFH and that staff “can’t counsel [mothers] about formula supplementation until the baby is seriously ill.” In fact,

“6) When a mother has chosen not to breastfeed, when supplementation of breastfeeding is medically indicated, and when supplementation is chosen by the breastfeeding mother (after appropriate counseling and education), it is crucial that safe and appropriate methods of formula mixing, handling, storage, and feeding is taught to the parents.”

Formula is not off-limits, even if a baby is not seriously ill, and mothers are not forced to breastfeed. Those who choose not to are required to be taught how to formula feed safely, which is certainly beneficial for babies. And for goodness’ sake, babies who need supplementation for medical reasons are not denied it – saying that BFHI promotes “mandatory starvation” is a bit extreme and misses the point.

You also say hospitals should “re-open well baby nurseries.” However, “Baby-Friendly designated hospitals are not required to close their newborn nurseries” in the first place.

I am not saying that the BFHI is perfect or that you don’t have some valid points, but I simply wish to point out that some of the central arguments you make are not accurate according to the BFHI guidelines.

And again, I would appreciate it if you could give me some references for the 5-15% statistic you mentioned, I would like to look into that more. Thanks

Bombshellrisa

Please tell us about your experience giving birth in a baby friendly hospital. It’s all well and good to provide the link to the guidelines and give your interpretation of the information provided, but that doesn’t mean that is what it translates into in real life. A hospital may not be required to close a well baby nursery, but they may not have the staff or budget to keep a nursery open, especially if it’s a room that is going to be empty since rooming in is a goal.

MJeano

If there are plenty of women who would prefer not to room in, as it sounds like you are suggesting (correct me if I am wrong), then well nurseries shouldn’t be empty at all. Also, at one of the hospitals where I work, the NICU also serves as a well nursery. For example, if a mother is recovering from a CS, the baby usually goes to this nursery until she is ready/able to have it with her. The babies who need intensive care are in the same room with the same nurses as those who are healthy but not in the rooms with their mothers. I cannot speak for all hospitals, but this example shows that just because there may not be enough need for a designated well nursery, it doesn’t necessarily mean there is nowhere else for well babies to go if not rooming in.

Daleth

Running a NICU is way more expensive than running a well-baby nursery. And what do you do when all the NICU beds are full but a baby comes in who actually needs the NICU? Where do you put the well baby whose room he needs?

That just doesn’t seem like a good solution to me.

Guest

Plus, the NICU is full of incubators, not beds. It’s inappropriate to put a well baby there.

guest

Also – you want as few people as possible in a NICU, to reduce the chance of delicate preemies getting infections. Visitors are restricted there, and all visitors have to scrub in and wear gowns. This isn’t what parents of healthy term babies want when they want to take a nap, and the increased germ traffic isn’t what parents of NICU babies want.

Charybdis

People have had experiences of having to beg a nurse to take the baby to the nursing station and keep an eye on it just so they can have a nap. This outstanding “option” is what happens when there is no well baby nursery available.

How is this a good idea?

guest

At many, many hospitals, however – including my own – women who have c-sections are expected to care for their babies immediately after being transferred to the postnatal ward. No well-baby nursery for them – it is *only* for babies who are sick, or mothers who are not on the postnatal ward due to some other complication. Being in pain and on medication from a c-section didn’t matter to my hospital.

Meanwhile, after I had my appendectomy, I wasn’t even expected to bathe myself alone.

Nick Sanders

I had a liver biopsy once. I wasn’t even allowed to change position in bed for 4 hours. You have to wonder why having a baby come out of you is considered as needing less recovery time than a tissue sample.

guest

Well, if you were a *woman* having a liver biopsy, they probably would have asked you to not only change position, but also change the sheets on your hospital bed. Woman can squat and have a baby right in the field! They can do anything!

Nick Sanders

Around the two hour mark, I’d probably have agreed to it if it meant they’d have let me go to the bathroom. My IV saline was set way too high.

LeighW

I can’t think of one other single circumstance where one patient is asked to take care of another in a hospital.
When you have minor surgery do they expect you to feed and change (the bedding) of other people? No.
Then why is it expected of women who’ve just given birth?

Bombshellrisa

Rooming in is a goal of the baby friendly initiative. If the goal is for babies to stay in the mother’s room unless they need the care of the NICU, there isn’t going to be a well baby nursery. I have yet to see the NICU take a baby whose mom just needs a break. The issue is usually staffing, the NICU nurses can’t be responsible for extra babies who just need to be watched so their moms can rest. No matter what women might want, if it’s not part of the plan and the budget there isn’t going to be a well baby nursery. That is two staff members that have to paid and all shifts have to be covered. One staff member has to be an experienced RN. That is a lot of nursing hours for a unit to pay for. The tour at the baby friendly hospital includes showing mothers how to push the bassinet into the bathroom or at an able in the door so the baby won’t be “left unattended” while the mom showers or uses the bathroom for awhile. It’s been made clear that nurses aren’t supposed to care for babies at the nurses station, meaning we can’t take them there for awhile if mom needs a break. No well baby nursery and we can’t put the babies in the NICU.

MJeano

The stories posted here about exhausted moms being left alone demonstrate the bigger issue in our culture (in the US at least) of lack of support for women in the postpartum period. Women DO need help, especially if they are recovering from a CS or difficult birth. But taking baby to a nursery is not the only solution to allow moms to rest, and they won’t have a nursery to send the baby to once they’re home (another reason why women need more support at home, too). To start, why can’t postpartum hospital beds have a co-sleeper attachment, such as this (http://www.scarymommy.com/hospitals-everywhere-should-have-this-amazing-co-sleeping-bed-for-new-moms/)? Baby has the comfort of being near mom without the risk of falling or suffocation, and mom has the chance to learn her baby’s feeding cues, regardless of how baby is fed. And if mom has someone available to support her, then visiting policies must allow them to be present any time of day. If she doesn’t have any outside support, there need to be sufficient staff in the hospital who can help. If the hospital’s budget doesn’t allow for paying extra nurses, why not hire (less expensive) postpartum doulas to help give moms extra support? These aren’t the only ideas, but they’re a start.

Bombshellrisa

Postpartum doulas aren’t cheap. They make more than most nursing assistants.
People always mentioned having extra staff and it’s a problem. Licensed staff is expensive and there are so many factors that go into how a unit determines acuity and patient to staff ratios. I worked for three years to develop an acuity tool for a med/surg unit. When you get more into nursing and have to be on the business end of how a unit works, you find that budget comes right before safety. There usually isn’t any change that isn’t facilitated by a sentinel event.

KeeperOfTheBooks

While I agree in general, there is the fact that once mom is home, certain factors aren’t in play that are in a hospital–or at least, aren’t as much in play.
I had a CS, and couldn’t get out of bed for almost 24 hours afterwards. The bed setup at the link would have helped immensely (though I’ll defer to professionals as to whether it’s safe–I worry about blankets, pillows, or even mom infiltrating baby’s space): one major issue was that I needed my upper body and arms to get out of bed, but I couldn’t reach to get kiddo in the bassinet because the bassinet was too high and didn’t have locking wheels. At home, I could lean over, put DD in her bassinet, and use my upper body and arms to get myself out of bed safely. Plus, my bed at home was much lower than that at the hospital, making it that much easier.
Once I got home, I also was 4 days post-op, and while I was still recovering, my physical abilities then were far greater than at 24 hours post-op. I don’t think it’s unreasonable to expect more help earlier on than later. I mean, I won’t have a nurse to check my incision and bleeding once I’m home; does that mean that they shouldn’t check them while I’m hospitalized?
Lastly, one issue is the baby that just won’t stop crying, even with a full tummy and a dry diaper. DD was the sort of baby who had to be kept moving all the time. There is no way on earth I’d have been up for walking her for hours immediately post-op, but going by her behavior once I got home, that would have been the only way to get her to stop crying at the hospital. At some point, a post-op/post-delivery mom just needs sleep, and she should have the opportunity to say “I’ve nursed and changed baby, and baby’s just not happy unless someone keeps her moving. She will not be harmed by having someone else take care of her for two hours, and I need sleep.”
Re PP doulas: locally, they make about $30/hour for overnight help. I don’t see hospitals spending that kind of cash, unfortunately, for a one-on-one aid for mom.

Charybdis

They might not be *required* to close their newborn nurseries, but when rooming in for all newborns is a goal to be attained, how are they going to achieve that goal if not by removing the *other* choice? Rooming in only. No nursery available for healthy newborns, sorry about that.

For nurses to require a formula feeding mother to undergo attempted re-education on breastfeeding each time the baby is needing to be fed, subjecting her to a lecture on how “breast is best” and trying to “reframe her thinking” by not only telling her formula is the worst thing in the world for her baby and making her sign a waiver stating that any medical issues that might arise with the baby will be attributed to the formula and that the mother understands the TREMENDOUS risk she is taking by feeding formula BEFORE EVERY BOTTLE IS PROVIDED, this, this is cruel harassment.

Some hospitals may not be so gung-ho about these so-called standards. But the staff, who actually deal with the patients, may have other ideas. When bonuses and raises are tied to “breastfeeding rates” and the exhausted mother is denied time to rest and sleep to recover so she can provide care to her baby, these things are wrong.

Do you really think, that in this day and age, a pregnant woman has NOT heard the “breast is best” mantra? It is not a matter of more support and education to bring those wayward women into the breastfeeding fold, after a certain point, it is harassment, belittling and condescending to assume that a woman using a bottle to feed her baby just needs *MORE SUPPORT/EDUCATION/INFORMATION*, a good course of fenugreek and domperidone and a nursing holiday to get her on the so-called right track.

We know “breast is best”, but we really don’t care anymore. We are reduced to not caring anymore by the overkill on the importance of breastfeeding; that all women can breastfeed, they just need to try harder, pump more, keep their babies hungry, etc, and are just over it. We have accepted it. Why the hell can’t you?

MJeano

First, Dr. Amy I am still waiting for a reference on the statistic you mentioned. How are we supposed to trust the “FACTS” you present without references to support them?

Charybdis, so you believe that the only way to achieve any goal is to take away all other options? I personally believe you can work towards a goal while still having other options for those who make an informed choice in favor of something else, but perhaps we disagree on that point.

I agree with you that it is not okay to harass women who choose not to breastfeed, and I think that one challenge with promoting breastfeeding is avoiding making women feel guilty if they are unable to or choose not to breastfeed for certain reasons (note that I did not say in my first post that the BFHI is perfect or that Amy didn’t have valid points). However, I disagree that women are harassed in the way you describe and find that to be a bit of an exaggeration. I would encourage you to read the guidelines in the link I provided; nowhere in there does it say that a woman must be lectured or sign a waver “before every bottle is provided.” It also does not say that she has to sign a waiver “stating that ANY medical issues that arise with the baby will be attributed to the formula”; if you can show me that such a waiver exists, then I would be interested to see it.

If a woman is required to sign an informed consent form and hear about the risks of an epidural before she gets one, do you also consider that harassment for her choice? I think most pregnant women have heard about the risks (even if they are small) of an epidural, but that doesn’t mean that she should not hear about the risks from the anesthesiologist in an effort to ensure she makes an informed choice. Similarly, formula-feeding carries risks (as does breastfeeding in certain circumstances, such as when the mother is taking a certain medication). The BFHI simply ensures that women are given a chance to discuss these risks if she makes the decision to formula feed and understand the impact it COULD have on future breastfeeding (if she hopes to eventually breastfeed).

Like you, I question whether nurses should have bonuses and raises tied to breastfeeding rates, though I personally am not aware of hospitals that do that. If you are, I would be interested in hearing which ones do so that I can look into that more.

And given how strongly you and many of the commenters on this blog feel about the wellbeing of babies (e.g. home birth in unacceptable because it may confer higher risks to babies), I am a little surprised that you don’t care about doing what is best for the health of babies. And just to clarify, when you say “we have accepted it,” and ask why I can’t, what is the “it” you are referring to?

Charybdis

I care about the health of babies, as well as the health of the mother. There have been plenty of people who post here that have related their tales of BFHI and their experiences with it. Things like there being no well baby nursery, forced rooming in with no chance for mom to rest, damn near forced breastfeeding attempts (someone, I can’t remember who, threatened the LC with criminal charges when the LC grabbed her breasts *without asking* and tried to latch the baby), other folks denied formula when they asked for it, some had to send a family member out to purchase formula because their request was refused.

Yes, you should have to sign informed consent forms when you are undergoing a medical procedure: epidural, biopsy, CS, whatever the instance is. I have absolutely no problem with that being mandatory. However, signing a form TO OBTAIN FOOD FOR YOUR HUNGRY NEWBORN is not even in the same ballpark. The baby must eat. Period. There are only two ways (really) to nourish an infant: breastmilk and formula. Pick one, or both. Neither is detrimental in and of itself, but things can happen.

Formula can be mixed incorrectly, because there is no education on it, liquid concentrate formula could be fed without dilution (like RTF) because there is no education. Given a country with a readily accessible clean and safe water supply, formula is safe to feed. It can be the ONLY option, if the baby has metabolic issues, allergies or food/protein intolerances.

Breastfeeding can fail. Some women will NEVER produce enough milk to satisfy and adequately nourish an infant, some women have a less than optimal milk quality, and some can produce enough milk, but only if the baby is nursing 45-50 minutes out of every hour. Some women hate it. Some women have traumatic experiences in their background that don’t make breastfeeding a viable option. Not everyone can breastfeed and not everyone wants to. It is not required to have a baby.

When I said “we have accepted it”, I meant that those of us who physically could not or did not breastfeed have had the “Breast is Best” BS shouted at us from everywhere: formula packages, diapers, billboards, commercials, etc. We do not need to hear more of the same message. Breastfeeding did not work for us/was not our choice for feeding our infants. We have moved on from that sticking point. We are “over it” and have accepted that for us (and other women), breast IS NOT BEST. We are fine with that. Why aren’t the lactivists? Why do they continue to harrass, harangue, preach at, berate, “educate” us? We’ve let it go and gotten on with life. Why won’t the lactivist do the same?

If you haven’t already, browse around these here parts on the blog, read some of the commenter’s experiences with the BFHI and how it is being implemented at different locations. Just because the so-called standards are written in a certain way, does not mean that they will be implemented the same way across the board. It is demeaning, bullying and removing choices from women. So how is it viewed as a good thing?

AllieFoyle

Supporting breastfeeding is fine, but the BFHI takes it to level of enforcement rather than support. Theoretically it should be possible to support BF and respect women who choose not to or have other needs, but when your process is geared toward BF and your documentation and professional goals and incentives are tied to raising BF rates, then you can’t honestly say that you are being respectful of other choices or needs. Breastfeeding is the major goal of the BFHI, not the needs and choices of individual babies and mothers. Therein lies the problem.

Many women have commented here about negative experiences with BF being promoted to the point of harassment, with mothers feeling enormous pressure and stress and babies sometimes going without food and adequate fluids. I’ve posted before about my own experience of being left alone overnight with my newborn (husband home with older child) after the nurses refused our request to take him so I could rest (sleep-deprived, exhausted, and in poor physical/emotional shape after difficult delivery). My baby cried inconsolably except when being held and nursed, I was crying and delirious with sleep, and terrified I’d drift off and drop baby on the floor. Other moms have commented that they experienced similar. And there is evidence that babies have died and been seriously injured when moms fall asleep and either accidentally smother them or drop them on the hard floor because of exhaustion and lack of help.

guest

“Breastfeeding is the major goal of the BFHI, not the needs and choices of individual babies and mothers. Therein lies the problem.”

THIS, exactly this.

Poogles

“And given how strongly you and many of the commenters on this blog feel about the wellbeing of babies (e.g. home birth in unacceptable because it may confer higher risks to babies), I am a little surprised that you don’t care about doing what is best for the health of babies.”

Not sure why it is surprising – the increased risks of one are nothing compared to the other. A few less colds and cases diarrheal illness across the entire population of infants is nowhere near the same as a 3-5x higher risk of DEATH at homebirth.

It’s not focusing on what is “best” for the health of the baby, but on what risks are acceptable and what risks are not – formula risks (given clean water and proper preparation) are tiny and short-term, the risks of homebirth (especially as is practiced in the US) are quite large and life changing. Even with the dire risks of homebirth, most everyone here (including Dr. Amy) believe that if a woman is properly informed of those risks she still has the right to choose homebirth.

Poogles

“If a woman is required to sign an informed consent form and hear about the risks of an epidural before she gets one, do you also consider that harassment for her choice? […] Similarly, formula-feeding carries risks (as does breastfeeding in certain circumstances, such as when the mother is taking a certain medication).”

So, do we need to start having hospital patients sign informed consents to get hospital food? After all, eating carries risks. The point being, formula is not a medication or treatment it is *food*, and if we don’t require consent forms for all food given in the hospital, then why do we need consent forms for this particular food item?

LibrarianSarah

Wait. You don’t have your friends sign a consent form before every dinner party?

Megan

“I understand that the food and cocktails provided may be so awesome that my mind may literally be blown. I further understand that dessert will actually rock my world.”

LibrarianSarah

Mine are more like “I understand that the food served here is barely fit for human consumption and might be overcooked, undercooked or previously dropped on the floor. I understand that this food probably contains sugar, gluten, salt, fat, etc and agree that I am eating here at my own risk. I also agree that if I wanted to complain about the food I would have to cook it my damn self next time.”

Megan

Mine is only as positive as it is because hubby does the cooking. Though I do make a mean classic cocktail. Aviation, anyone?

Bombshellrisa

Yeah, I like that!
Mine would mention that there is fat and/or alcohol in everything available to be consumed.

Roadstergal

“Similarly, formula-feeding carries risks (as does breastfeeding in certain circumstances, such as when the mother is taking a certain medication).”

Breastfeeding carries risks in the absence of medication. If the mom doesn’t make sufficient milk, and/or has delayed lactogenesis (very common), and/or the baby struggles to latch, the baby is at risk for dehydration, starvation, and jaundice. Moms are exhausted in the post-partum period, and there have been a scary number of case reports of women suffocating their babies after falling asleep while breastfeeding in BFHI hospitals. Why don’t breastfeeding moms have to sign a form indicating they’ve been informed of those risks?

Megan

“Why don’t breastfeeding moms have to sign a form indicating they’ve been informed of those risks?”

Thank you! True informed consent discusses the risks and benefits of ALL OPTIONS. To not discuss these things with women is not true informed consent. The risk of a baby suffering brain damage from hypernatremic dehydration or kernicterus from delayed lactogenesis is REAL. Personally, I think more mothers would choose to supplement judiciously if their milk was slow to come in if they knew these risks considering they pale in comparison to the small, theoretical risks to the gut microbiome that a few mL’s of formula poses.

Poogles

“However, I disagree that women are harassed in the way you describe and find that to be a bit of an exaggeration.”

So do you believe the women are lying who are recounting their experiences in Baby Friendly hospitals that include being denied formula, harassed for using formula, denied the option of not rooming-in?

“he had lost nearly 30% of his body weight in 3 days, they aim for 10% at the most. I felt angry, I had told them my baby was starving. Any time I had asked for formula I was told it would affect my milk supply and refused…I had to sign a form allowing him to have the bottle. He gulped it down and went straight to sleep. The first time really since he had been born. The next morning when with a new midwife when I asked for another formula top up I was given a spiel on how ridiculous it was to have given it too him in the first place and I would destroy any chance of ever having any milk.” – http://www.fearlessformulafeeder.com/2012/09/introducing-the-family-friendly-hospital-initiative/

“For our efforts, I got cracked and blistering nipples and extreme sleep deprivation, and baby got absolutely nothing. She made her displeasure known at ever increasing volumes, until she got so exhausted she stopped trying and slept continuously. I was in the middle of my ‘baby blues’ period and literally hadn’t slept since the c-section as I was told to latch and pump every 3 hours day and night to get my milk in. […]As befits a baby friendly hospital, mom and baby couldn’t be separated under any circumstances ever, so the midwives stepping in for any of the night feeds was out of the question.[…] When I begged the midwives to help me get at least some sleep, they flatly refused. I had to keep on trying breastfeeding, under no circumstances would they consider taking the baby for part of the night or letting me skip the fruitless pumping. Didn’t I want what was best for my baby? And, driven by guilt, I soldiered on.” – http://www.skepticalob.com/2012/12/a-cardiologists-experience-with-a-baby-friendly-hospital.html

Who?

What are the risks of formula feeding?

Bombshellrisa

The baby might be fed by someone else!!!

Who?

Gotcha. Shocking.

Bombshellrisa

And surely traumatizing for all involved. Wouldn’t want the baby to possibly bond to anyone else or be cared for by anyone else.

Roadstergal

Can’t have baby liking dad.

Nick Sanders

I bet if you tried to explain to these NCB people that as far as bonding goes, feeding pales in comparison to contact comfort, you’d either get blank stares or an argument, even though we have the experimental data (with primates no less!) to prove it.

Bombshellrisa

I thought you have written a thesis, surely you know how to do research? Where did you get your source that proves Pitocin interferes with breastfeeding?

swbarnes2

Not breastfeeding in the first few days puts your child at far higher risk of being readmitted for Neonatal Dehydration. The OR for EBF babies is 11.2! In this study, 25% of babies were formula fed, only 2% of the babies readmitted for dehydration were formula fed.

How many LCs do you think are sharing this risk with the women whom they are lecturing about breastfeeding?

Roadstergal

“I would encourage you to read the guidelines in the link I provided; nowhere in there does it say that a woman must be lectured or sign a waver [sic] “before every bottle is provided.”

Really? That’s _exactly_ what this sounds like:

“When a mother specifically states that she has no plans to breastfeed (see steps 4 and 5), or requests that her breastfeeding baby be given a breastmilk substitute, the health care staff should first explore the reasons for this request, address the concerns raised and educate her about the possible consequences to the health of her baby and/or the success of breastfeeding. If the mother still requests a substitute, her request should be granted and the process and the informed decision should be documented”

guest

That may be in some BFHI document, but it is not what is actually happening in hospitals. I was never given ANY information on safe bottle preparation – even though I was exclusively bottle feeding my preemies (pumped milk, but it doesn’t matter what’s in the bottle – you need to know how to clean and sterilize them properly).

The well-baby nurseries are disappearing due to “rooming-in policies.” My hospital did not have one. Either your baby was sick and in the nursery, or it was with you. No exceptions. No overnight visitors. BFHI may not *require* them to close the nurseries, but they gave them the excuse to do it. And babies are dying, and moms are suffering.

Madtowngirl

The BFH I delivered in required us to attempt breastfeeding before they would release us to the recovery floor. My baby was preterm and thus her blood sugar was being monitored. It was very clear that she was getting nothing from my breasts – her blood sugar kept going down. Yet I was never given formula, and one of the LCs even told me my baby was getting enough (her blood sugars proved she wasn’t).

So maybe it’s not what the initiative meant to do, but it certainly is happening in practice.

In short, they found that the infants of 12% of women (15, if they included women with any breast surgery) did not gain a sufficient amount of weight exclusively breastfeeding in the third week of life, despite doing everything recommended to boost supply.

If you have any data suggesting the number is lower than 5%, I would be interested to see it. Unfortunately, the literature is riddled with references to this “5%” number without actually citing the data- they cite another paper, that cites a review, that cites a textbook, etc, and some of the older papers just throw the number out there as a given (based on hearsay?) without citing at all.

Roadstergal

And that citation is from over 20 years ago. Women are having their children at later ages and having fewer of them (first-time moms have higher rates of delayed lactogenesis – according to even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine, almost half of first-time moms need supplementation). So these days, the percentage of women who _need_ formula at the hospital to keep their babies from starving is probably even higher than 15% – which is already high enough to make the BFHI activities unconscionable.

And of course, this doesn’t take into account women who simply don’t want to breastfeed for their own personal reasons. Why do the lactivists never respect that?

Valerie

Right? Yeah, there are a lot of reasons why this isn’t the “be-all-end-all” estimate of what percent of women could EBF if they could be convinced to try hard enough. It’s just literally the only estimate I could find that had any data behind it. The 15% does not include the women with delayed lactogenesis- early supplementation didn’t put them in the “insufficient” category. They were only considered to have insufficient supply if they weren’t making enough by 3 weeks. So, yeah, even by their data, much more than 15% will need supplementation in the early days. That study also included only healthy women and term infants who wanted to breastfeed exclusively, so sick infants and women who needed incompatible medications were out.

Maybe there are some other studies out there that indirectly measure this. There are some obvious problems, though, like selection bias, that would make it difficult. Eg, if women sense that their babies are not getting enough, they supplement, taking them out of the EBF category.

… In any case, it would be good to know what this number (or even better, a personalized version) is to set realistic expectations for mothers who want to breastfeed. Even if it’s “We can’t say for sure, but there is a 45% your baby will need some formula in the first few days to prevent dehydration. We’ll show you how to do that while building your supply.”

But you are completely correct: if 95%-100% of women could breastfeed, they still don’t need an excuse to feed formula. This isn’t a doctor’s note to get out of gym class- they are adults making decisions about their bodies. And this formula-is-toxic rhetoric is irresponsible, even if it were only a tiny minority who had a good-enough medical exemption from breastfeeding.

MJeano

Thank you for posting this article. I haven’t suggested that only less than 5% of women don’t have enough supply – I honestly don’t know, and you said yourself that this is the only estimate you found with any data behind it, not to mention it’s 26 years old. That is why I’m asking Amy for references (a request she is still ignoring). If she is going to claim something is a “biological FACT,” I would expect much more current research to support that assertion.

I don’t currently have access to the full article you linked, so I will have to see if you can answer a few of the questions I have about it (I am not necessarily doubting the validity of the numbers, just have questions). To clarify, is the 12% number based on women with no breast surgery? Were there any other abnormalities they were looking at in this population? The reason I ask is to figure out whether the study population is representative of the whole population, or if they recruited more women with certain characteristics they were trying to investigate, in which case the 12% number may not be representative of all women. I would also be curious to know the rates of women who had minimal prenatal breast enlargement and minimal postpartum engorgement, since both of those do seem to suggest an inherent biological cause.

The problem I have with Amy’s article is that by using terms like “biological fact” and “biological reality,” Dr. Amy is implying that 5-15% of women and/or babies have some inherent characteristic that makes them unable to produce enough milk without leaving room for the possibility that there can be external factors at play. Simply saying that 5-15% of women have inadequate milk supply (though Amy still hasn’t provided a reference on that, so we can’t verify if those numbers are correct) doesn’t tell us whether the cause is an inherent characteristic independent of any external factors that occur after birth, or whether some situational factor (e.g. separation of mother and baby after birth, illness, tongue tie, etc.) is the root cause of the inadequate milk supply. I am not denying that some women do indeed have some inherent characteristic that causes low milk supply (as the linked study actually suggests), but Amy’s argument suggests that no matter what we do, there will ALWAYS be 5-15% of women who cannot produce enough milk. I want to see the evidence that shows that. I’m arguing that SOME cases of inadequate milk supply can be caused by factors over which we do have some control; to write off all cases as being just “part of nature” without looking at what we can do to prevent the problem does women and babies a disservice. What the exact rates are, I don’t know; again, that’s why I’m asking Amy to provide sources. It’s like saying it is a biological fact that X% of people will have a heart attack, when in reality there are external factors (diet, exercise, etc.) that influence the chance of a heart attack.

Furthermore, this study (http://pediatrics.aappublications.org/content/pediatrics/early/2013/09/18/peds.2013-0724.full.pdf) shows that women’s concerns about breastfeeding influence how early they stop. They found that 40% of women had concerns about their milk quantity, a concern that was significantly correlated with stopping breastfeeding earlier than intended. 40% is much higher than both the 5-15% of women with insufficient supply that Amy suggests and the percentage of participants in the study with clinical signs of of insufficient intake, suggesting that some of the women who have concerns about their milk quantity actually do have enough milk. If this concern is leading these women to stop breastfeeding sooner than planned, then articles like this that lead women to doubt themselves may actually be contributing to earlier cessation of breastfeeding. Amy, why don’t you stop scaring women and actually contribute constructive ideas toward a solution that works for everyone? Surely we can find a middle ground.

Valerie

I’ve answered some of your questions about this study before in other comments, but I will copy and paste here for you:

“The study sample consisted of 319 healthy, motivated, primiparous women who were breastfeeding term, healthy newborns who were appropriate or large for gestational age (AGA or LGA). Recruitment of 442 women was achieved through local childbirth education classes, the offices of obstetricians and family physicians, newspaper announcements, and distribution of study flyers. Pregnant women 18 years of age or older, anticipating a singleton birth, and planning to breastfeed exclusively for one month or more were enrolled during their last trimester. Informed consent was obtained for participation in a study of “the early breastfeeding experience among first-time mothers.”
Subjects gave birth at various hospitals in the Denver area, where the breastfeeding initiation rate exceeded 70 percent during the study period. Community perinatal care standards were highly uniform, and typically included rooming-in, breast- feeding on demand, and avoidance of routine supplements for breastfed infants. Mothers usually stayed 24 to 36 hours after vaginal delivery and 3 to 4 days after uncomplicated cesarean birth. After delivery the study provided subjects with continuous access by means of telephone or pager to the Lactation Program’s medical staff of pediatric physician assistants, under the supervision of the principal investigator.”

12% of the women who had no incisions on their breasts from previous surgeries were unable to produce enough milk to feed a 3-week-old baby, despite “prenatal preparation for breastfeeding and continuing intensive intervention. ” The number of women who do not make enough for, say, a 3 month old baby is probably larger. I could not find a study attempting to find the true percentage of the population who make insufficient milk- and I might guess why: it’s really hard to convince parents to let their children go hungry. If a mother believes that her child isn’t getting enough (eg, reading satiety cues, falling off growth chart), she will supplement before waiting for “clinical signs of of insufficient intake.” If a mother prioritizes making sure her child is fed over waiting for clinical proof that breastfeeding is insufficient, then you never really know *for sure* if she had insufficient supply.

… and actually, in the link you posted, the numbers are consistent. You are conflating delayed lactogenesis with long-term insufficiency. At day 3, 40% had concerns about milk quantity, which is consistent with Alison Steube’s number (44%) having delayed lactogenesis. By 60 days, that number dropped below 20%, which is closer to the 15% Dr. Amy reported.

The reason I brought up the 5% number is because that is usually what people say- “only 5% of women really do not make enough milk” – and there is no data behind this, as far as I can tell (and I tried), yet it persists, even in the literature. I think everybody here, including Dr. Amy, wants women who want to breastfeed to get all the information and all the support they need to do that. However, informing mothers that inadequate supply might be a problem is not “scaring women.” If Dr. Amy had changed the language to be more like “The best available data are consistent with 44% of first time moms having delayed lactogenesis and 15% never make enough milk to support a growing infant,” would you be satisfied? The point is that it’s not rare, but that breastfeeding proponents often assume that it’s negligible, and that even the best possible practice (pumping, feeding on demand, etc) leaves some babies hungry.

Poogles

“I simply wish to point out that some of the central arguments you make are not accurate according to the BFHI guidelines.”

“We have been ordered to move all formula, nipples and pacifiers to the back room of the nursery (which has also undergone a name change to make it less accessible and friendly sounding) so that NOBODY sees it, patients or family. We don’t want them to think we promote formula or artificial nipples. We are instructed now to council every mother who has chosen to formula feed, or do breast/bottle combo on the “dangers of feeding formula to your baby”. Yes, these very words were uttered and in writing. There’s serious talk of making the mother sign an informed consent before giving the baby any formula- acknowledging that she is aware that she is causing harm to her baby by giving him/her formula, and that they understand that breast milk is superior to formula. […] We have to now keep all the shades in the nursery down so that people don’t look in, and THINK it’s a nursery and again to make it an in-accessible place.“

Madtowngirl

I should have stopped reading at the first post. I went into the forums further…and let’s just say, I hope some of those commenters are not nurses in my state.

swbarnes2

There are just too many stories; clearly many hospitals are ignoring the letter of the guidelines in favor of their spirit, which is to bully all mothers into following an agenda that is not better for mother or baby.

MJeano

I agree that there seems to be discord between the spirit or intention of the BFHI guidelines and how they are implemented, at least in some cases. No woman should be forced to breastfeed, ESPECIALLY not by physically grabbing her breast and forcing the baby on. I do understand that breast is not best for everyone – such as one mom I supported who, after several days of trying to overcome her baby’s nursing strike, said that it simply wasn’t worth it to battle with her baby anymore; it was clear that the stress and frustration nursing was causing was certainly not best for mom or baby. And like I already said, the challenge is to still encourage and support breastfeeding without forcing or making moms feel guilty if they choose not to.

That being said, there still do need to be standard hospital practices in place to protect the establishment of breastfeeding for those mothers who choose to nurse. In general, breastfeeding DOES have a steeper learning curve, and what happens in the early days after birth can and often does have an impact on future breastfeeding. It’s important to keep in mind the other end of the spectrum that was part of the impetus for creating the BFHI. Previously (and still, in some cases), standard protocols at hospitals were detrimental to breastfeeding – babies whisked away for newborn procedures immediately after birth with no chance for skin to skin; all babies sent to nursery, where busy nurses often don’t notice early feeding cues, so by the time baby is brought to mom to feed it is crying (causing a rise in cortisol levels) and too upset to latch well, thus causing more stress for mom; or, baby is given sugar water or a bottle without mom’s permission, so it is too full to nurse when she tries (and possibly leading baby to prefer the bottle and refuse to nurse at all). Neither of the extreme ends of the spectrum is good.

The discussion here has demonstrated that the BFHI guidelines are perhaps not as clear as they should be, and that there needs to be more oversight as to how BFH hospitals are implementing the guidelines. But instead of digging in our heels and name-calling, let’s think about ways to support and encourage breastfeeding without forcing or guilt-tripping. Dr. Amy accusing all BFHs of “mandatory starvation” without putting forth any real solutions isn’t going to get us anywhere. What changes can be made to the wording of the guidelines? Which points are most important to keep, and what, if any, should be taken out? What should be added?

One idea is for there to be more emphasis on education about feeding options and their benefits/risks during the prenatal period, rather than when mom requests formula in the hospital; I think we all agree that women should be fully informed of the benefits and risks of ANY option, whether home birth or feeding method or anything else. However, it still is important to address the reasons for why a mom requests formula, if her intention had been to exclusively breastfeed, so that she can be given appropriate help if needed. One study found that women’s early breastfeeding concerns are correlated with cessation of breastfeeding by 60 days (http://pediatrics.aappublications.org/content/pediatrics/early/2013/09/18/peds.2013-0724.full.pdf), and the authors point out:

”In a qualitative study of reasons for in-hospital formula supplementation among low-income mothers of infants under 12 months, DaMota et al concluded that new mothers commonly lack understanding about the breastfeeding process; thus, the misinterpretation of appropriate newborn behaviors often leads to maternal requests for infant formula.”

I’m not trying to imply that women simply need to “try harder” or just need more support and breastfeeding will be a breeze; but in some cases, help with understanding cues or addressing an underlying problem, like latch, may be what she needs. If it is clear that the baby still needs supplementation, or the mom has no desire to continue trying, then by all means the baby must be fed.

Roadstergal

“When a mother has chosen not to breastfeed, when supplementation of breastfeeding is medically indicated, and when supplementation is chosen by the breastfeeding mother (after appropriate counseling and education)”

That’s three ‘ands’ in a row. Mom has to choose, the formula has to be ‘medically indicated,’ and mom has to choose (boy howdy, that’s not well written). So if one of them is missing, the formula is locked up. So a mom who doesn’t want to breastfeed _has_ to – in the absence of a ‘medical indication.’ Which is not spelled out. So there’s a lot of latitude there. There are mainstream midwives claiming that 10% weight loss in a newborn isn’t ‘medical indication’ for formula.

Also, note that even this grudging release of limited formula is explicitly only allowed for ‘supplementation’ purposes. The mom will still, following the guidelines, have to be trying to breastfeed to a degree that the staff considers ‘appropriate’ in order to be allowed formula.

Also also – there is a TARGET for both breastfeeding and for babies who have NO supplementation at all. Do you think this is something that isn’t going to influence decisions? Do you think hospitals won’t try to make a baby ‘tough it out’ for two days of starvation to make that only-14%-supplemented goal? A goal in the context of a ~44% rate of delayed lactogenesis in primps?

Also also:
“When a mother specifically states that she has no plans to breastfeed (see steps 4 and 5), or requests that her breastfeeding baby be given a breastmilk substitute, the health care staff should first explore the reasons for this request, address the concerns raised and educate her about the possible consequences to the health of her baby and/or the success of breastfeeding. If the mother still requests a substitute, her request should be granted and the process and the informed decision should be documented. Any other decisions to give breastfeeding babies food or drink other than breastmilk should be for acceptable medical reasons and require a written order documenting when and why the supplement is indicated (see Appendix 2 for acceptable medical reasons).”

So moms can’t just request that their babies be fed, well, food. They have to agree to sit there and try to be talked out of it and shamed into not Doing What’s Best for their babies.

And yes, I do highly recommend taking a gander at Appendix 2.

Cidalia Martins

The article bears out my experience with baby-friendly hospitals. I had latching issues in the beginning (not fixable…baby was just on the small side, so her mouth was small), and I was told flat out that they couldn’t give me any formula. It only got worse from there. Lactation consultants, nurses, etc. in and out of hospital missed all the clues that my daughter was starving and being dehydrated, despite my very vocal concerns. She almost died. I should’ve followed my gut and supplemented sooner.

amazonmom

Baby friendly is the biggest letdown of my career. I wish I had a HIPAA safe way to talk about the disasters I see far too often. Just feed the baby instead of literally starving it please. Please.

Bombshellrisa

I have missed you! When I drive up your way, I wave : )
Wondering how long it is going to take UW Valley to wise up to the CPMs at Puget Sound Birth Center’s newest location, across from UW Valley.

veggiegal

In more advanced societies, these human babies, if they were lucky, didn’t starve – they were being fed by a “wet nurse”. This practice is as old as the book of genesis… And common enough to be in the old testament multiple times… I wonder what lactivists would say about these biblical women who weren’t able to feed their own babies. Clearly, they must have not tried hard enough -shame on them.

Queen Victoria had 9 kids and had a wet nurse because she didn’t want to breastfeed AND because she was busy being queen. Apparently even being queen there were people who disapproved of her choice. Side note: Some people also disapproved(in print! in The Lancet!) of her using chloroform for her last 2 deliveries

“These facts being perfectly well known to tile medical world, we could not imagine that any one had incurred the awful responsibility of advising tile administration of chloroform to her Majesty during a perfectly natural labor”

KeeperOfTheBooks

Sorry to keep posting in this thread, but something just came up that seemed appropriate.
A friend of mine just had her first baby via CS. Yay, healthy mom and baby! However, friend is absolutely out of it right now. She was exhausted going into the CS, and apparently reacted to the spinal/painkillers by falling totally asleep on the table and staying that way for the next few hours. Still very sleepy/drowsy. She’s planning on giving BFing a shot, but isn’t hugely invested in it.
Her sister is her support person. This hospital has no nursery, and will not take the baby for maternal relief. Sister, who is my best friend, was just told that she isn’t allowed to stay in the room with mom tonight, presumably because she isn’t daddy. They’ll let her sleep in the waiting room (?!), and if her sister needs her at some point, she’ll be allowed to go back and help. Apparently, she’s supposed to psychically forecast at what point mom is going to be exhausted enough to drop the baby?
This shit, pardon my language, has got to stop. Leaving aside anything else, under pretty much any circumstances it’s considered a CPS-worthy parenting decision to leave your newborn in the care of someone who is exhausted out of her mind, on narcotic painkillers to which she isn’t accustomed, and unable to get out of bed. Why is this different?

BeatriceC

I just mentioned somebody else saying that the hospital wouldn’t allow another person besides Dad to stay overnight. Seriously, this is classism and elitism at it’s ugliest.

Chi

Exactly! What are same-sex couples supposed to do?

Or what about a woman whose partner has split before the baby is born and wants mom/sister/best friend there as support?

Or how about women whose partner just CAN’T be there for whatever reason, be it military deployment, work, or other siblings that need attention?

I think you should be able to designate a support person who is allowed there at whatever time 24/7 for the duration of your stay no matter what.

BeatriceC

Or, as in the case of my youngest, a woman who’s husband decided that the life of husband and father wasn’t his cup of tea and took off as soon as he found out his wife was pregnant again.

Thankfully, the “support person” issue wasn’t an issue for me for multiple reasons, not the least of which was that he was a 24 week preemie and in the NICU (and after the first 10 hours or so, not even in the same hospital), so overnight care wasn’t an issue. But also because the hospital’s policy was just one person overnight, and it didn’t matter who it was, just that the mother approved of that person.

Who?

The whole idea of having to explain oneself just does my head in. ‘I’ll be in hospital having a baby. One, some or all of Fred, Mary and Jill will be around.’

Move on.

KeeperOfTheBooks

A bit belated, but I meant to reply to this a week+ ago and got distracted.
A mom in a FB group posted some months ago about the idiocy of her local hospital. Mom is a military spouse; dad was deployed during the birth/PP period, so mom arranged for her own mom to come stay with her for a couple of weeks to help. Very sensible.
Mom ended up with a CS. She decided to BF. However, the hospital informed her that her mom wouldn’t be allowed to stay overnight as her support person, and that taking baby to the nursery wasn’t an option either. Why? Because “we expect fathers to stay with their wives and babies overnight to encourage bonding,” and taking baby to the nursery might interrupt breastfeeding.
Mom pointed out that this is great, and no doubt Daddy would much rather be at the hospital, but that wasn’t an option, so how about letting her mom stay in order to help with changes, baby-walking, and, yes, nursing tips? “No, we don’t allow that”–with the strong undertones of “how dare your husband not be here, he must be a lousy father.” Mom was understandably upset and worried about the upcoming night, when she’d be soloing baby care despite not being able to get out of bed.
I never did hear how it ended up, but I suggested that there must be someone on base whose job it was to make the lives of military spouses a bit easier during deployment, and that this person, as well as the media, should be contacted to raise the fifty shades of hell that this idiotic policy deserved.

Who?

This is the time to call the hospital’s patient care representative, and have a to the point conversation, in which your friend does most of the talking. Short sentences, small words. No smiling. She might benefit from practising in front of the mirror (yes I’m serious).

‘My sister is clearly unwell. You have two choices. First-her preference-treat her baby like your patient and care for him/her. Second, if baby is not your patient, hand over care to the person who is here to support your patient. That person is me. What are my qualifications? Why do you care, if baby is not your patient?’

Your friend must ask for and make a written note of the name of every person she speaks to from now on, with their staff position and any other identifying info. Make notes of what they say. Make it clear this is happening.

Step up, or step out is the shorthand message. If that person can’t help, get the hospital lawyer down. Then the GM, CEO or whoever. Calm. Small words. Short sentences. Copious written notes.

Good luck.

MaineJen

Can the sister just refuse to leave? And ask to speak to someone higher up every time they try to get her to leave? That’s seriously ridiculous.

Amazed

That’s ridiculous!

D/

Hospital’s have visitation policies that make sense most of the time. When they don’t make sense someone has to advocate (sometimes assertively) for what does.

Recently a father whose wife was in ICU with a deteriorating status was having to constantly run back and forth between the ICU and the postpartum room with the baby. For two days the baby would go to the nursery every time he went to the ICU because we have an ‘only adults with armbands can be alone with baby in the room’ rule and there are only 2 bands per baby, no exceptions … He was wearing one band and mom the other.

This left his entirely from out of town family camped out in the hallway staring through the nursery window at the baby and crying every time he was in the ICU and had him crying when he was updating me on my rounds. His sister was willing to be the designated adult to care for the baby in his absences, but we had a no-exceptions rule that no one was working around.

Solution? I went to the team leader (and suggested she go to our manager) with a suggestion to use a copy of the sister’s driver’s license on the baby’s chart as an alternate means of ID as needed and the understanding that the baby could not be transported in the hallway by family members. (It’s a strict security measure at our hospital for newborns on our floor to be transported in cribs only and by banded adults.) Two minutes later dad’s informed, ID’s copied, and no one’s crying in the hallway … and my manager wasn’t even involved and had ZERO problem with it when she was notified after the fact.

Her sister needs to advocate for them (assertively, if necessary).

An Actual Attorney

Might be time to demand to speak to the head of legal. Or whichever lawyer is in charge of risk management.

rh1985

That is insane that they refuse to take the baby to give mom a break, but won’t allow the mom to have a support person other than the father stay in the room. That totally neglects the needs of single moms and moms whose partners can’t take off work, are deployed, or need to take care of older kids.

KeeperOfTheBooks

Thank you all so much for your comments! I passed along the ones with suggestions to my friend. 🙂
As it happens, it pretty much worked itself out once the night nurse came on. Night nurse not only thought that having a support person in the room with mom was A Good Thing, but made sure that my friend was good and comfy with a warmed blanket on the pullout bed. She then offered to have baby come hang out with her while she walked the halls between his feedings, so both mom and her sister got a relatively decent amount of sleep, only having to get up for feeds.
I have strongly suggested an extremely nice letter to hospital admins, once mom’s feeling up to writing something of the sort, about how awesome this night nurse was and how nice it was to have relief.

Who?

Love the night nurse. Glad everything’s sorted.

AA

Such gall on the part of the hospital. Did you know that when there is no nursery, you still get billed the exact same room fees as if the baby was in a nursery? It’s pretty sick.

KeeperOfTheBooks

Oh, I can believe it. It’s a win-win situation from the hospital’s financial perspective: charge the same amount while cutting costs. That is, ’til that first massive wrongful death/malpractice suit hits…

BeatriceC

Random OT question for the medical people on the board: 14yo with a history of newborn kidney reflux, kidney injury approx. 9 months ago (traumatic fall from skateboard), appeared to resolve. Past three months complaining of intermittent flank pain, left side (same side as skateboard injury). No blood in urine, but occasionally enough to cause him to curl up into a ball and be unable to move. Question brought on by acute episode this morning. Will be calling pediatrician in the morning for an appointment, but I’m curious if I should be pushy for a more emergent exam (same day appointment, or should I take him to the ER). He seems otherwise fine. I’m all good with orthopedic stuff, but pretty much everything else is out of my field of experience. This is the figure skater, so for him to be doubled over like this is alarming, but with everything else looking hunky-dory, I don’t want to overreact. Also, we drove up to Los Angeles for my MIL’s birthday, so we’re a few hours from home and the hospital with all his records.

The Computer Ate My Nym

If he’s feeling okay now and it’s been going on for 3 months, you’re probably safe leaving it until he can see his regular doctor who has all his records. That being said, if you see anything you don’t like, go to the ER. That’s what they’re there for. He may have something like a stone. It might not have moved enough to produce enough bleeding to see with the naked eye yet, but could start causing pain or bleeding again at a random moment. Hope all goes well and he recovers quickly and completely!

One last thought: You might want to check for fever. Kidney infections are no joke and I’d say take him to an ER right away if he has a fever. (Though I’m guessing if he’s feeling fine how he probably doesn’t have one.)

BeatriceC

Thanks. That was my general intuition, but I started to doubt myself. My plan is to call the led in the morning to get an appointment reasonably soon, but not emergent unless they think he needs to be seen sooner.

DelphiniumFalcon

Just to second what Nym said about the blood. My dad and I are champion kidney stone passers (though one year stone free for me! *knock on wood*) and we almost never have visible blood in our urine. It’s almost always picked up by more sensitive testing.

Also seconding the kidney infection. Even though I pass stones kidney infections if they’re bad enough can get right up there pain wise. Had them wake me out of a dead sleep screaming in pain. So if he says it feels like someone smacked him across the back with a baseball bat, that’s what my kidney infections feel like. He may try to tough it out but he may also regret it a few hours later. I prefer to go to the emergency room ASAP but I’m also waaaaay over trying to tough out pain that I know isn’t going to go away. It’s like running the original Marathon. Yeah, you made it, but you also dropped dead at the end. Pain really does do a number on your body…

Charybdis

Yeah, I’d be worried about a kidney infection and/or stone. (This is what I do for a living….analyze kidney stones). A stone of any size can cause pain, especially if it is starting to move down the ureter, and if it is big enough to block kidney drainage, then you can get kidney damage and more stone formation. The largest stones I have seen are infection related: struvite (magnesium ammonium phosphate) is highly associated with urea-splitting bacteria (infections). They can be large and are often called “staghorn” calculi because they can fill up the internal spaces in the kidney and look like horns.

I see stones from all ages, I had one from a three year old the other day, so his age shouldn’t preclude the possibility of a stone. A lot of people will form stones because of a high calcium and/or high oxalate diet. Lots of milk, dairy, etc and a fondness for tea (high in oxalates), berries and dark leafy greens can often cause a stone to form.

As long as he is feeling mostly fine, isn’t running a fever or having renal colic pain or isn’t passing discolored (red, rust brown, dark yellow) urine or cloudy or strong smelling urine, it probably isn’t emergent and can wait until you get home. Push the liquids and cranberry juice, if he will drink it.

UTI’s are no fun; I get them occasionally and they go from “I think I might be getting a UTI to passing nearly straight blood (bright crimson urine!)” in as few as 4 hours. But I’ve got a slightly screwy urinary tract to start with.

KeeperOfTheBooks

Another thought that occurred to me: in many families, the newborn isn’t the only kid who needs mom’s attention.
I admit that my experience BFing DD was particularly negative and unfruitful (in the sense of “I didn’t have anything to give her,”), but she was the first kiddo. If breastfeeding this one would be anything like it was with her, it would be grossly unfair to her to try. DD deserves a mommy who can cuddle her a lot to help her through the transition to being a big sister. She deserves a mommy who isn’t going, inevitably, to snap and yell at her for touching mommy or baby brother and thereby disturbing his latch during hour-long nursing sessions. (I couldn’t take a deep breath or move when nursing her or she’d unlatch.) She deserves to get out and see the world and the park and the pet store and friends and do the things a toddler loves to do, not be closeted in the living room for months at a time because mommy can’t go anywhere lest the baby need to eat. Hell, she, as well as the baby, deserves to be fed when hungry, not be told “not now, I have to nurse/pump.” A newborn will understandably eat up more of my time and attention than a toddler, but that doesn’t mean that the toddler isn’t my kid, too, with all that that implies.

CSN0116

I have a lot of reasons for not BF-ing. The number one reason is exactly as you describe. I have five children; they all have a lot of needs and I’m not willing to compromise my time spent with the others for something that yields little to no return for the infant.

I would rather go to work to pay for their private schooling, trips to see the world, and summer camps. I would rather have the free time to read with them, go over homework, cook good meals, engage with them …you know, all the shit that *actually* yields very real returns on how “smart and healthy” kids turn out.

Jules B

Being a mother of an only, I never really thought about bfing from this POV, and of course you are totally right that the experience/limitations are necessarily different when you have an older child or children to think about. Yet another reality of life the lactivists do not acknowledge!

guest

This is what I thought of every time people told me it must be so hard to have twins. It was hard, but I’m not sure it was harder than having an infant and a toddler. Toddlers cannot be put down in a crib while you attend to a more needy sibling, after all. They not only have needs, they also have the ability to move around and get into things on their own (and they are quite good and getting themselves into danger).

Old Lady

My first two were twins but because they were first I was able to dedicate my time to breastfeeding them but I had supply and latching issues so I combo fed. With my third child I ended up having to supplement a little anyway once husband went back to work, even though I have not had supply issues this time. Up to this point with my newborn I could have EBF if I didn’t also have to take care of the twins, and they are preschoolers so more independent but more troublesome than they were as toddlers.

Puffin

As we discussed breastfeeding in a tutorial group, we had one objective on supplementation. We included discussion on indications for feeding of breast milk substitutes (the official terminology in use.) To the list of illness-related indications for supplementation I added “Maternal choice.”

Can I go up to someone who is a match for someone in kidney failure and harass them until they agree to donate? No, I can’t. It’s unethical, even though them choosing not to donate may well kill the other person. I don’t know why it’s acceptable to harass new mothers to use their bodies a certain way (a likely painful, limiting, difficult way at that!) over a few less colds and episodes of diarrhoea.

Meerkat

I don’t quite understand why hospitals are so interested in this BFHI designation, does it mean they receive additional funding? Tax breaks? Can someone elaborate on that?
More importantly, what concrete steps can we make to change this?

AA

Market share. Maternity services are often seen as a “gatekeeper” to possibly adding more patients. If a woman delivers at X hospital, she may choose to keep her other medical services at X hospital too. In addition, there is a perception (I don’t know if it’s true backed by statistics) that women get male partners to go to the doctor, and thus has you’re essentially getting the whole family into the system.

You can see this by the way the maternity services in my town advertise spa showers, special menus just for postpartum, mood lighting, different flooring, etc than the other units.

The importance of breastfeeding in the US is the most championed by middle class and upper class white women who are more likely to have insurance.

“Mothers, we’re Hospital A and we are Baby Friendly! Don’t you want to use us instead of Hospital B which won’t be supportive of your breastfeeding and bonding goals?”

guest

Healthy People 2020

Nick Sanders

What does that mean?

D/

He’s referring to the fact that the US Healthy People 2020 initiative includes “Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies” among their national objectives for improving the health.

HP and the CDC have actively promoted EBF for the first 6 months for many years and BFHI has definitely been used as a marketing tool among facilities by calling attention to differences in the “quality care” provided.

Honestly, for the US, once JCAHO made reporting the Perinatal quality bundle mandatory for almost everyone, whether or not a facility has– or is seeking– BF-designation has become irrelevant.
For any who may not know the perinatal bundle’s five quality indicators are:
● decreasing elective delivery rates at <39 completed weeks
● decreasing cesarean birth rates
● increasing antenatal steroids from babies delivering <=24 and 300 deliveries per year must be “working toward” a 70% EBF rate and the Ten Steps (the framework the BFHI is built on) is the declared pathway to make that happen. At our last survey breastfeeding was such a specific focus that an LC was expected to be immediately available for the surveyors questions for the entire 3 days.https://manual.jointcommission.org/releases/TJC2015B2/MIF0170.html

Nick Sanders

I certainly see the reasonableness of bullets 1 and 4, and I kinda understand 3 even if I don’t have the knowledge to call it good or bad, but 2 and 5 seem extremely arbitrary.

Sidenote: you can make ≥ with Option + . at least on my computer. Option + , gets you ≤ and Option + = gives ≠. It’s all very handy 🙂

D/

Yeah 1, 2, and 5 all have a significant downsides with any universal application to individual circumstances.

Sidenote:
(the effort to learn to navigate the keyboard on the grandkid’s tablet) ≥ (aggravation of a partial cut-n-paste/ typo from JCAHO’s website + a necessary ugly-edit correction) ≤ (the compulsion to now go fix said ugly-edit)
😉

Sue

That list is a mixture of processes and outcomes. As Dr Amy always says, we need to focus on altering the results of processes, not the processes themselves.

rh1985

The only ones that make sense to me are 3 and 4. 5 should be entirely the woman’s choice, 2 risks denying CS to women who want them as well as waiting too long to do a medically indicated one, and 1 is problematic because it’s causing hospitals to ban pre 39 week deliveries based on soft indicators that suggest baby would do better out than in.

Meerkat

It must be nice to be naïve. Unicorns, fairies, hospitals investing in healthy future generations… Not the reality though. It’s money. Everything is tied to money.

Sue

There is no “chronically” in newborns – they are – newly – born.

Your colleague previously commented that newborns have stomachs the size of a marble. The XRay confirms that their stomach volume is greater than the size of a marble.

And you are also wrong about toddlers and adults. Stomachs are muscular – there is no “chronic distension” except in pathological cases of gastric outlet obstruction. If the stomach could not contract, how could it propel its contents forward?

Fat people do not have bigger stomachs than thin people. Gastric surgery for weight loss reduces the size of a NORMAL stomach volume to far below normal – it does not “fix” a distended stomach.

How little insight does it take to come to an OBs blog and spout such nonsense?

guest

No, people who overeat whether skinny or fat have larger stomachs. And after gastric bypass—the stomach that was reduced can stretch out.

Sue

No, guest, they don’t have “larger stomachs”. You clearly have no idea about this.

Please read up instead of ponitificating.

And btw, I have shown you clear evidence that newborn stomachs are larger than marbles.

Squillo

Perhaps my cynical side is showing when I note that the two baby-friendly hospitals in my area happen to be the two public hospitals–the ones that serve primarily un- and underinsured populations.

Sue

Public hospital are:
1. More subject to government regulation; and
2. Less sensitive to patient demands.

Lurkerette

I was so glad that our hospital still had a well-baby nursery — I preferred to room-in, but my husband had to leave to care for our three-year-old as we have no family within 1500 miles and I worried that I’d fall asleep with the baby in my arms — and even more glad that my midwife (CNM) thought I was asking an obviously bizarre question — of course there’s a night nursery! We’re not animals, Lurkerette!

IME, they were great. They asked and confirmed that I didn’t want her to have a bottle, but that I was okay with a soothie, and I had lots of support for breastfeeding (unneeded in our particular case, but there are probably some peasant wet nurses in my ancestry). Supporting breastfeeding hardly requires being a jackass to tired new moms.

Allie P

In case y’all aren’t tired of hearing the story: the only time I was shamed for public breastfeeding, in the 19 months I’ve breastfed (2 babies), was in a breastfeeding class in the high security lock down private family lounge of the mother baby wing of the “baby friendly” hospital where I gave birth to #2. I was also told I was “holding her wrong.” (I was holding her in the cradle position). I don’t think lactation consultants know which end is up, honestly.

Allie P

Also, I was called and shamed by THREE different LCs (the hospital’s, the OB’s, and the pediatricians) after checking out and supplementing with formula. Here we are, 9 months later, I’m still nursing, and half of those months I was nursing exclusively. So, screw you lactation industry. Supplementation HELPED me.

MissKate

I’m just waiting for the day a baby actually dies in one of these hospitals.. And everyone will act so surprised, asking how this could ever have happened?! *head meet desk*

MaineJen

It’s happened…babies have been dropped or smothered from bedsharing with tired mothers.

“In the only published scientific study of the problem, reported in August in the journal Pediatrics, researchers estimated that 600 to 700 such falls occur every year in the U.S.

Dr. Robert Christensen and colleagues at Intermountain Healthcare in Ogden, Utah, identified 14 accidents in which a newborn fell to the floor among more than 88,000 births at Intermountain hospitals.”

AA

“Verbal reminders,” LOL, like that works when there’s nursery. “Hey, don’t fall asleep, parents, it’ll be your fault if you fall asleep after having nowhere safe to put your baby while you sleep!”

Intermountain has a Special Care Nursery. THere is no mention of a “well baby” nursery.

The Power Point does not mention the availability of a nusery for children. Just “promote rooming in,” right?

Clorinda

Unless things have changed tremendously in the last 2 years, Intermountain still had a nursery when my last one was born at the hospital I delivered at. And I’m pretty sure others of my friends who recently delivered there had the nursery option. Maybe they renamed the “well baby” nursery to the “Special Care” nursery to get the BFHI designation without loosing the nursery.

DelphiniumFalcon

I’m pretty sure all three of the intermountain hospitals in my area have a nursery that’s not restricted to odd.cases. I know the one I work in has rooming in options and a nursery. They’re also not zealots about breast feeding since after an issue where a mother’s family member was mixing formula wrong and the infant was losing weight a nurse saw the prep being done wrong and now mothers and family members who prepare formula are now offered to have a nurse or LC watch and give tips on prep.

My.coworker just delivered a few months ago and doesn’t breastfeed and wasn’t bullied over it. She’s the type that would have been pretty.vocal.over it. So I don’t know what IHC is doing different in my area but it seems to be working to help accommodate choice without brow beating new moms.

EmbraceYourInnerCrone

Yes exactly! It seemed like they realized there was a problem(or got their asses sued by parents) but their solution doesn’t address the actual problem. I even noticed a page that mentions not making some kind of med/painkiller standard in Rx orders anymore because then the mothers might drop their babies. It was really bizarre! They realize theres an issue and then don’t really fix it (the mentions at the end of Redesign maternity beds…ummm so the babies can get smothered by their exhausted mothers instead of dropped..WTF

AA

One of the ideas from the presentation is the mothers will put the babies in slings or wrap the baby on a blanket on the mother’s chest.

Great, so instead of falling, the babies can be suffocated.

Roadstergal

Hey, that’s a nice solution for exhausted new moms. Less effective pain control.

Spamamander

That was my thought too! “Well, we don’t want you to be too sleepy and drop your baby. So just be in pain instead.” Pardon my French, but fuck that.

momofone

Keeps ’em alert, you know.

AirPlant

I feel like there is something to the bed design. Everyone that I have spoken to thinks that the hospital bassinets are kind of bullshit, there has to be some kind of solution that makes life easier. If they are going to expect room sharing they could at least have the grace to make it physically possible for the woman to put down her baby without having to get up first…

KeeperOfTheBooks

Heartily agreed. They are a freaking nightmare, and a liability waiting to happen. Waaaaay back when I got my CNA license, one of the biggest things that got emphasized was the importance of safety in transferring patients, especially locking the wheels of whatever you’re getting the patients into/out of (beds, wheelchairs, etc) and making them as close to the same height as possible. How on EARTH is it considered safe for moms below about 5’8″ or so to be unable to even reach all the way into the bassinet they’re supposed to be putting baby into from their beds, especially when the damn wheels on the bassinet don’t even lock? What, toss your newborn at a moving target? Oh, yeah, totally safe…

Jules B

Agreed! I remember at one point laying in the hospital bed, and looking *up* through the clear sides of the hospital bassinet and thinking, “I must remember to mention this stupid bassinet design to (someone we know who designs stuff) so they can create a better version and we can sell it and get rich!” Hah.

MI Dawn

I don’t know what “obnurse” in his many incarnations tells moms. All I know is that when I worked in hospitals, we told the formula feeding moms to follow baby cues, NOT what was in the bottle. If the baby took 1 out of the 4 oz, that was fine, as long as the baby was satisfied. If the baby took 4 oz and was screaming for more, give it more (along with appropriate burping, etc). No baby was to be forced to eat a certain amount (barring those who were hypoglycemic and didn’t want to eat….).

Obviously, BF babies weren’t being watched for oz. But we did document weight changes and wet diapers, and told the moms to watch for at least 6-8 wet diapers a day. If less than that, to contact their doctors to check for weight loss and dehydration. Most BF babies had md appointments for weight checks at 2-4 days after discharge.

I’d worry if he was a nurse in a hospital caring for me or my daughters.

The Computer Ate My Nym

I’d like to say that there is no chance that “OBnurse” is really an OB nurse, but then I consider that Ben Carson is really a neurosurgeon and Andrew Wakefield is really an MD (if now unlicensed) and I can’t find it in my heart to claim that no actual OB nurse could ever possibly be that miseducated and/or ignorant of biology.

demodocus

My kid overfed all the time, off my oversupply.

Linden

Hey, MrObnurse has hit upon the cure for obesity in adults! Simply starve newborns, so their stomachs don’t become distended, and presto! End of obesity crisis.

The Computer Ate My Nym

Well, except for the little problem that it’s starvation early in life, not being well fed early in life, that is associated with later type II diabetes.

You know, I’ve sometimes wondered about my newborn days and feeding. There’s a whole host of other factors that contribute to my current overweight status, but I do wonder. My mother always told me how “awful” it was sometimes when I was a newborn. She’ll tell you any chance she gets how I nursed for 90 minutes straight every two hours (from the start time, not the end time), for the first few months of my life, and how I was always an ill tempered baby. Now I don’t think she was neglectful, and looking at my baby book, I did gain weight, but very, very slowly. I’m told that the pediatrician didn’t think much of it because my birthweight was 10 pounds, 12 ounces and my mother weighed 89 pounds pre-pregnancy, so they just figured it was genetics correcting my size from my very large birthweight. Turns out I really am built more like my father, and in his family, 10 pound+ babies are common. I have to wonder how “ill tempered” I really was, or if I was just freaking hungry. I sometimes wonder if my mother is such a rock star about newborn feeding (feed the baby, supplementation is a good thing, and so is EFF if that’s what it takes to keep the baby fed for whatever reason BF isn’t working out) because she wonders about the same thing.

guest

Or maybe you were trying to soothe your colicky self.
And yes, your mother was a rockstar! She knew what was best.

You really, truly are advocating starving a baby, aren’t you? You’re not even hiding it anymore.

BeatriceC

I posted the numbers above, but I got curious enough to dig out my baby book. I actually was starving, but from what I’d been told, even the doctors were blowing it off to “correcting my size”, thinking that I’d really inherited my mother’s family’s body type (super tiny) instead of my father’s family’s body type (NFL linebacker type) in spite of birthweight evidence saying otherwise. And again, for the record, I definitely inherited my father’s body type. These days I’m 5’8″ and back before I had kids and was skinny enough to work for Hooters I still weighed 165 pounds. Small is never a word that can be used to describe my physical appearance.

BeatriceC

Actually, I don’t think so. I got curious enough after I posted last night to actually look up the details. I was 10 pounds, 12 ounces at birth. By 4 weeks I was 8 pounds, 15 ounces. By three months I’d managed to gain a little bit and was 11 pounds, 4 ounces. Looking at those numbers, I’m actually lucky to be alive and non-brain damaged. So my mother was breastfeeding me for 90 out of every 120 minutes around the clock, and not thinking that an almost 20% weight loss might be contributing to my “ill temper”. Meanwhile, those 30 minutes out of every two hours she had free from feeding me were almost certainly insufficient to properly take care of her older child, who was a pre-schooler at the time. She most certainly did not “know what was best” for either of us.

My mother is not a nice person, but she is *now* a rock star when it comes to early infant care. These days she’s quick to support supplementing or exclusively feeding with formula if trouble arises. I do think that she probably knows better now, and has some amount of guilt over my newborn days, and that accounts for the change of heart.

demodocus

Its like nobody ever comfort eats.

guest

So your logic: breastfed babies are starving? That makes sense.

demodocus

if your milk doesn’t come in for 5 days, the kid gets pretty hungry. Day 6 I had plenty, day 3-5 I supplemented, because early on day 3 he had his first check up and had lost 12% of his birthweight.

Obnurse123

Blogs like this are fear mongering. Hospitals ARE NOT denying mothers formula. Mother’s are asked whether they will be breastfeeding or formula feeding. If they are formula feeding the baby will have bottles or formula. Hospitals are NOT taking a newborn and making the mother attempt to breastfeed. Theses fear mongering blogs are depressive to women, especially expecting mothers. Always check the sources of blogs, especially those citing Wikipedia, and remember most blogs are based on emotion and opinion versus fact.

Zornorph

This blog is based on a lot more than that as those of us who follow it regularly know. And I have read and heard too many stories about women who were pressured and bullied in hospitals because they wanted to formula feed.
But let me ask you this – why would you object to changing the name of such a program to ‘Breastfeeding Friendly’ rather than ‘Baby Friendly’? How is this program ‘Baby Friendly’ in the first place?
I’m a guy – nobody tried to make me breastfeed. But the lady who came by on day two to take pictures of kiddo said she was glad that I was letting Kiddo use a pacifier and using formula because she’d come across so many who were not getting enough milk and it make them so unhappy it was close to impossible to get good pictures of a baby who was screaming. And that wasn’t even in a ‘baby friendly’ hospital, that was just mums who felt the pressure from outside.

The Bofa on the Sofa

This blog is based on a lot more than that as those of us who follow it
regularly know. And I have read and heard too many stories about women
who were pressured and bullied in hospitals because they wanted to
formula feed.

But Z, don’t forget:

I think the sources and dramatization of the actual situations should be considered.

IOW, those are just hysterical women overreacting. Why should anyone take them seriously?

CSN0116

I had a nurse HUG me once to congratulate me on my decision to EFF and not “buy into all this nonsense”. She told me the formula fed babies are more peaceful and more content, and the mothers are happier and easier to work with :/

Sue

It’s great if there are areas of good practice, but we’ve also heard direct accounts of many instances of poor practice.

Should this be ignored?

Obnurse

I think the sources and dramatization of the actual situations should be considered. I have a VERY hard time imagining even an idiot of a pediatrician not finding concern regarding an infant with a 10% weight loss. Do I think an automatic 10% weight loss after mom had 6 liters of fluid during delivery means automatic supplementation to an asymptomatic baby? No. But I think mom’s should be informed on how to PROPERLY prepare formula and why, she should be informed that new research is showing a higher incidence of type 1 DM and leukemia in formula fed infants, etc. So that in 5 years if her child is diagnosed and she reads about this risk somewhere else she cannot say “I could’ve, should’ve, etc.” Mom’s have 1,500 visitors every day yet cannot room in because they’re exhausted? I think visitors should be banned from maternity wards so mothers can rest instead of stressing and staying awake to entertain visitors after giving birth.

momofone

Or we could treat them like, I don’t know, ADULTS, and let them decide if they want visitors. And maybe even let them decide if they want to room in.

Mrobnurse

Byt, they are so tired and ill….they cannot take care of their babies….other units within the hospital strictly limits visitors for safety concerns.

momofone

Really? I’ve had a fair amount of experience in hospitals and have never had visitors limited. Though I’m quite capable of saying I need to rest and asking people to leave if need be.

Mrobnurse

Obviously you’ve never been in an ER or ICU to visit. Visitors are limited because patients need to rest and do not need to be over stimulated and staff needs to be able to get to the patient without tripping over visitors.

momofone

I have, in fact. And have been a patient in both.

Amazed

Still scratching my head over the question if ED and ICU stay is a patent characteristic of women in the aftermath of Mrobnurse’s care. It must be, else I don’t see why he would mention it when the topic was a L&D stay.

momofone

I think he was trying to say that those units tend to limit visitors, so if I’d had unlimited visitors, I must not have been in either unit. (He was wrong, but I think that’s what he meant.)

Amazed

In the context of postpartum women having visitors, I still fail to see how ICUs and EDs are relevant. It’s like “Women in Africa should breastfeed because clean water” and then “Women in the first world should breastfeed because women in Aftica and clean water.”

Sue

EDs and ICUs are very different situations to wards.

Firstly, they are relatively crowded places with lots of action, equipement and sick people. Second, happy events are generally not happening there.

Tip for Mr and Ms OB nurses: neither of you have acquitted yourselves well here.

Both Dr Amy and many of the commenters appear to have vastly more knowledge and experience than either of you. Suggest you stop and read instead of commenting so much.

KeeperOfTheBooks

Wait. Lemme get this straight.
1) Postpartum women shouldn’t have visitors, and 2) postpartum women don’t need nurses to help them because their visitors should be doing any support necessary.
Glad we’ve clarified that, then.

The Computer Ate My Nym

new research is showing a higher incidence of type 1 DM and leukemia in formula fed infants

Cite sources. I am very dubious of this statement.

Spamamander

Particularly considering there almost never is a known ’cause’ for leukemia and Type 1 diabetes tends to be almost exclusively genetic in origin..

Seriously. “guest” keeps posting the same link in response to all the requests for information and links.

One trick pony, perhaps?

guest

“guest” is very close to driving me to sign up for an actual Disqus account so as not to be mistaken for him/her.

Charybdis

You could be “guestnotTHATguest” ;P

guest

Until our new “guest” decides to use THAT name to be confusing (as has happened to me on another blog). I like my anonymity, so I guess I must suffer the tribulations that come with it.

BeatriceC

Create a burner email addie with no connection to your real life (fake name, birthdate, etc) and use that to register for disqus. Beatrice is definitely not my real name. It’s an alter ego taken from a 16th century Italian woman who’s famous for killing her father. I might have a bit of a morbid sense of humor.

guest

I have some of those already for other sites. We’ll see. Maybe I’ll make yet another one.

BeatriceC

I have a few. I finally broke down and created a document that lists all the emails along with whatever information I used to create them, none of which are actually my real personal data. I kept forgetting what information went to which account.

The Bofa on the Sofa

I am the one true Bofa on the Sofa.

Who?

I just type mine in every time. I’m not logged in to disqus, so can’t upvote, but apart from that it seems to work okay.

Secondary source, not peer reviewed research, though they do cite primary sources. Why don’t you pick out one of their primary sources that you find compelling to support your view and then we can analyze the data from it.

Chi

I think you’re greatly exaggerating the number of visitors new mothers have in hospital.

Here in New Zealand we have strict visiting hours (with exceptions for partners) and are only allowed a maximum of I think 3-4 people in the room at the time. Though I think that’s more a fire safety thing.

And I can only speak for my experience whilst I was in hospital postpartum, but my parents and my husband visiting were the ONLY times I got rest because they could hold the baby while I showered/ate/whatever.

Plus you can only get so much ‘rest’ with the nurses and lactation consultants buzzing in and out.

I think closing well baby nurseries is criminal as mothers should have the CHOICE whether they want to room in (after fully understanding the risks) or send their child to the nursery.

guest

No, I’m really not. A room of 5-12 visitors plus dad, plus siblings after a delivery. It is crazy. Then visitors trickle in and out ALLLLL day long. It’s no wonder new moms are exhausted and dropping their babies.

momofone

Those damn siblings wanting to see their new brothers and sisters.

Nick Sanders

Almost as bad as those dads, just hanging about the place all damn day, trying to “be near my wife and child” but refusing to do the nurse’s job. The nerve!

Chi

Oh and the fact that they’ve been through hours of labor and may be on strong pain medication for tearing or a c-section has nothing to do with them dropping their babies?

guest

So…because *some* mothers have a lot of visitors, nurses shouldn’t help any mothers? You make no sense. I had ONE visitor. ONE. And it was my aging mother, who was not able to help with much. She certainly wasn’t permitted to stay overnight and help me with lifting babies out of a bassinet with a fresh c-section incision and inflatable leg massagers (for blood clot preventions) that essentially tied me down to the bed.

Azuran

So that’s his solution to the problem. Instead of letting mothers decide if they want to room in or not, let’s also prevent them from sharing the joy the the birth with their family and friends. ‘guest’ is really against choice all the way.

Sue

Well said, Azuran. Visiting at birth is very cultural. IN some communities, it would be disrespectful NOT to visit a new baby.

These various incarnations of “Ob nurse” seem to have very little understanding of nursing. Or hospitals.

Linden

What, visitors should be banned? They are helping you do your job! I wanted to be out of hospital at the earliest opportunity because I was having a hard time coping with lifting the baby, and not falling asleep while feeding him. I wanted to get home because my mother, who’d just flown 2000 miles to see us, could help more than the nurses were helping.
Also, do tell us why it is not a concern if a baby of a mother who has had IV fluids during delivery loses 10% BW. What percentage of IV fluid ends up in the baby? Be specific. Cite sources, please.

KeeperOfTheBooks

He/she has elsewhere said that postpartum moms shouldn’t rely on nurses for help because they have visitors. I don’t think consistency is a strong suit in his/her/its worldview.

Amazed

Would you show us the new research that shows those higher incidences of diseases? With other factors excluded, just formula being the only culprit?

Of course “mom’s” (sorry but if you’re repeatedly unable to spell the plural of the women you’re working constantly with, I have a hard time believing that you can understand the studies that you want to shove down their throats) shouldn’t be allowed to entertain visitors! After all, they need to conserve their energy for being 24/7 available for their babies because nurses shouldn’t have additional tasks, right? Let’t delegate it to moms!

Zero research. Learn the difference between UNICEF and studies… as well as propaganda and studies.

MI Dawn

Citation needed for that new research, from peer-reviewed journals (you can just give the PMID if you like). Otherwise, I call BS.

Moms can always limit their visitors. But even if they don’t, why should they be forced to have the baby in the room 24/7 when they would perhaps prefer to sleep/nap with the baby in a nursery, feeding on demand? Every hospital I worked in was happy to take a nursing baby out to mama as much as needed, on any shift.

Then what is your excuse? Because that is not a link to the studies themselves. Just the propaganda bullet point overview presentation designed to make people feel as if they have read and analyzed the actual studies.

Amazed

UNICEF? That’s a study now? What comes next, a UNESCO paper? Sounds a little like UNICEF. Just something lazies like you would love because that’ll make them feel informed without making the actual effort. Besides, it sounds impressive.

swbarnes2

Do you not understand that people will be able to document things happening that you “can’t imagine”? Someone had a link a few months ago to a scary facebook story about just this thing…the pediatrician kept saying “don’t supplement, don’t supplement”, and then the kid went unconcious during the car seat test, and had to stay in the hospital longer.

Nick Sanders

Said “1,500” visitors are capable of standing up and supporting their own body weight without someone holding them.

Sue

“new research is showing a higher incidence of type 1 DM and leukemia in formula fed infants”

How do recommendations from 3rd world countries apply to industrialized nations with clean running water?

The Bofa on the Sofa

I just looked up one of the claimed “diabetes” papers. It looked at glucose levels, NOT diabates, and the UNICEF website says:

“The authors conclude that higher intensity of lactation was associated
with improved fasting glucose and lower insulin levels at 6–9 weeks’
postpartum and argue that lactation may have favourable effects on
glucose metabolism and insulin sensitivity that may reduce diabetes risk
after GDM pregnancy.”

The “authors … argue that lactation MAY HAVE favourable effects … that MAY REDUCE diabetes risk.” Oh, and that only applies to a GDM pregnancy.

That’s the world of great new research? It “may have” favourable effects that “may” reduce risks?

That’s some pretty serious knot-twisting to get a benefit.

BTW, I should also note that paper did not even require EBF, and found no difference with some minor supplementing.

Charybdis

Perhaps “guest” is not reading the whole paper, or is just looking for buzzwords. ‘Cause you know, if it is in print or on teh interwebs, it must be true.

Sue

The site doesn’t even link to many of the full papers – one needs both access to the studies and the ability to analyse the methodology. I suspect “guest” has neither.

Nick Sanders

I just looked at another, a case-control study about T1D in infants and their siblings. It looked at “123 children with diabetes mellitus type 1 and their respective siblings”. Even if each of those 123 had 5 siblings, that’s still not even N = 1000. Beyond that, here’s the info they say they gathered:

Data on infant feeding during the first year of life, prenatal care, gestational age, delivery, birth weight, and immunization status were collected through information provided by the mothers.

I notice there’s no mention of other potential cofounders like birth order, family income, maternal living situation, postnatal health of the children beyond immunization records, or other cofounders that might affect breastfeeding duration.

Sue

OK, “guest”. In I went, but I also swam around down there. That taught me a LOT about the propaganda associated with the BFI concept.

First, the WHO is concerned with health WORLDwide, as the name suggests. There are many impoverished communities where breast feeding is much better than feeding with contaminated water or diluted formula. None of these factors operate in hospitals in developed countries, however.

Next, I learned that the site is full of pseudoscience.

Other than the known minor decrease in respiratory and gastro infections in the first year, and the incidence of gut complications in the significantly premature, the evidence for all the other alleged benefits is poor.

You see, “guest”, the fact that a publication exists doesn’t mean the evidence is valid. People who are familiar with implementing evidence into policy and practice understand that there is a lot of noise in the body of literature in any particular area, and it;s important to be able to assess the quality and validity of the evidence. Single studies are never accepted as solid evidence of anything.

So, let’s look at a few examples:
– Alleged protection against urinary tract infections – they cite only two studies – both are case control study of children presenting with a first time diagnosis of urinary tract infection. The site only links to the abstracts.

Case control studies start with the diagnosis and look backwards at factors that are in the cases but not the controls. It appears that they have not controlled for many other factors. There are a large number of factors that influence the incidence of UTIs in babies.

Also, the difference disappeared after 7 months of age. UTIs are RARE in these small infants, so the figures are likely to be so small as to be spurious.

The comments in response to the paper also discussed the reliability of the diagnosis.

– Alleged protection against ear infections: four papers are cited, including two that are not about breast feeding (one about pacifier use, one about cleft palate. The prospective cohort study used nasopharyngeal swabs – not clinical diagnosis of otitis media.

So, again, invalid “evidence”

And so on.

So, “guest”, if one does “dive in” to the actual evidence and analyses the quality and validity of the studies cited, a very different picture is obtained in comparison to what one sees if looking down on the surface of the water, as you appear to have done.

D/

(Mr)Obnurse(123),
I’m a firm believer in feeding every starved, or even just hungry, thing I run across (except maybe trolls) so I had to debate a bit with myself before replying, but I’m feeling 10.8 + 12.something + 13.6 + 19% stabby after this week. Why?

Because that’s the percentages of weight loss for four of the exclusively breastfed babies that a partner and I were involved with this week who required direct intervention on our part to convince their parents and/or pediatricians that feedings beyond breastmilk should be immediately mandatory in these babies’ cases … and yes that’s NINETEEN percent weight loss from birth! Well all that, and your equating “trust your body to provide milk” with an ability to do so down thread personally pushes a button for me.

I am (and have always been) all about mothers who are wanting *and able* to exclusively breastfeed having the support needed to do so. Over the years I’ve stopped more nurses from automatically giving formula to a hungry baby without first assessing and assisting them with breastfeeding than I’d care to remember. I’ve been known in the past to stop nurses mid-sentence for referring to hungry babies as ‘starved’ with a soapbox speech, “We don’t starve babies here. Choosing that word burdens parents with the guilt that goes along with the idea of having starved their child … who isn’t. Don’t use that word.” I still don’t use the word with parents but no longer chastise nurses automatically until I have the full story. And I have, out of frustration, even point-blank questioned a pediatrician in a particular case with “Is starving this baby our plan?”

Having to beg or bully people into feeding starving babies is a completely new development for me, and it has coincided with the exclusive breastmilk feeding quality measures associated with JCAHO and BFHI accreditations. These are not idiot pediatricians. They’re the same pediatricians I’ve known and worked with, many for over twenty years, who are being influenced by exclusivity expectations outside their personal practice and by the reluctance of families, after doing their research, to use any formula (even when it is obviously necessary). Simultaneous aggressive promoting of breastmilk **exclusivity** and the risks of formula along with a lack of sufficient breastmilk availability for all babies may not have been intended to cause such issues, but it really shouldn’t be unimaginable … much less even that surprising.

I hope you listen to families in your care better than you listen here, btw. I won’t argue that this is an uncomfortable place, but I doubt I’ve learned more anywhere else to improve my practice. Listen a bit (and shout less) you may learn more than you could imagine too.

Amazed

D/, your post was very sad where weight loss is concerned but not feeding the troll part was truly great.

D/

*blushes

Tiffany Aching

OK so you’re not satisfied with telling new mothers how they should use their breasts but you also think they should be denied the possibility of having visitors ? Personally I don’t think I would want to have visits after giving birth but I completely get that other people would want their family and friends to meet their baby. It’s a personal choice. You should really stop guessing what’s best for your patients and start listen to them.

Erin

That’s precisely what happened to a friend of mine, not only did they try and stop her leaving until they were happy with her breastfeeding (talking days after a straightforward birth), she had to argue with no less than 4 staff members to get formula. Had she actually been supported rather than bullied, she might have combo fed but she wasn’t.

I imagine it depends a great deal on the hospital but given the BFHI essentially says the same thing in their own literature, I think we can safely say its happening in a lot of hospitals.

Also having been diagnosed with Ptsd and Pnd, I’ll tell you one thing that really doesn’t help new mums and that’s sugar coating.

indigosky

Actually yes, they are denying formula to women, or making it extremely hard to get it. I know plenty of women who had to listen to lectures, be forced to sign pieces of paper saying your kid will end up fat, sick and dead if you use formula, etc. Do us a favor and actually read real stories that are posted in the comments here or on the Fearless Formula Feeders blog.

Oh wait, you don’t want emotion. Guess what, having your body controlled by nurses grabbing your breast when you told them you are not going to breastfeed, bug off, is going to make you emotional. I had that happen with #2. I slapped her wrist away and told her to get the hell out or I was calling the cops for assault. I then had no less than FIVE people come into my room asking if I was sure I wanted formula. I finally got it.

EmbraceYourInnerCrone

If performance reviews and raises etc depend on ones percentage of mothers who initiate breastfeeding, the nurses and the hospital and the LC have a vested interest in MAKING people breastfeed.

Jules B

Exactly what I was going to say. That was the case in the hospital I delivered in – the nurses had their bonuses tied to bf initiation rates. Plus, interestingly, I only found out about that little factoid because a friend of mine was an L&D nurse there at the time. It is not something the hospitals publicize, it seems. Wonder why they keep that info on the down low?

D/

It’s not only initiating breastfeeding in my case but rather “Increase exclusive breastmilk feeding percentages during the hospital stay by 10%”. Granted it’s only one (not extra-weighted) item among several pages of expectations tied to determining salary increases … but it’s there on everyone’s annual performance plan.

A vested interest in making mothers not just try … but in making them ONLY breastfeed!

Heidi

Except, yeah, they are denying women formula. If you say you are breastfeeding, they will not bring formula if it’s not working out. I really don’t think women are lying about their experiences at “baby friendly” hospitals. I didn’t even get formula despite baby with low blood sugar until 24 hours of low blood sugars. He got his heels stuck before they’d let me nurse each time. Even then they wouldn’t bring me some nipples to hurry and get food in the baby! They tried syringe feeding and an SNS but when a baby’s glucose is low, you are fighting with their urge to fall asleep and end up burning more calories trying to eat than receiving. His sugar only went up when some sane nurse got some nipples and he got in a decent amount in a short amount of time.

swbarnes2

You know that saying “This never happens” is going to cause about five women to reply “It happens to ME” in the space of 20 minutes, and about 20 might say the same thing in the next 4 hours? Are you going to say that the experiences of women are just opinions, and not facts?

guest

I was not asked whether I was breastfeeding. I was assumed to be breastfeeding.

Amy

And this is, once again, going to hit women and babies in poorer or remote areas the hardest. A woman in Boston or New York can easily hospital-hop given the number of high-quality options available; surely they won’t all be “baby friendly.” But a woman in the middle of nowhere, Wyoming? If her local hospital is “baby friendly,” she doesn’t have many choices.

indigosky

I live in Los Angeles county area and my only choices are one step below Baby Friendly. There is not a well-baby nursery anywhere nearby, the few options that don’t get me on one of the nastier freeways are all room in, no choice. So it can be just as bad for women of means in larger cities.

EmbraceYourInnerCrone

I delivered my daughter in Long Beach in the mid-1990’s and rooming in was expected of you, if you had a vaginal delivery. Luckily they still had a well baby nursery and you could take the baby down there for a few hours and get some sleep. Something I really needed as I could not sleep and had the shakes for hours after she was born. Well baby nurseries should be the rule not the exception.

I’m in Ontario, and I can’t hospital-hop. You are sent where your practitioner has privileges, and increasingly, where there is space available to deliver you. I delivered in a BFHI, and overall, the hospital itself was positive experience. But I understand why some folk don’t like BFHI.

guest

Ehhhh….I chose my NYC hospital based on how quickly I could get to it in case of emergency or precipitous labor. Like many New Yorkers, I don’t own a car, nor did I have a support person with a car. When labor came, I was going to have to take a cab, and I couldn’t afford to just cab wherever I wanted in the city. Some women can, but a lot of us cannot. And we sure as hell aren’t going to take the subway while in labor. So the choices aren’t necessarily all that plentiful.

Jules B

You know, I look back at pictures of my daughter in the early weeks when I was still trying to EBF, and while she didn’t look sick-sick, she did NOT look like a healthy baby. She looked small and sleepy/weak and just not 100% “there.” Once she started getting truly full feeds because I added formula to breastmilk, she became chubby and bright and lively. And it makes me mad because if I had not had the lactavists chanting “breast is best” from every corner, I KNOW I would have just given her formula right away. I am her Mom, I knew she was just hungry! I knew it, but I ignored that instinct because of the chorus of voices telling me I was wrong. So frustrating in retrospect.

Zornorph

I have seen over and over the Breastapo saying that babies are supposed to look ‘thin’ and that plump babies with round cheeks are ‘fat’ from drinking formula. I guess the ‘waif look’ if popular among that set.

Nick Sanders

What the hell?

Zornorph

I’m not at all kidding – they will tell you that a plump baby is a fat one and that they are supposed to look thin. And the idea that we should want babies to look plump is a formula-feeding conspiracy. Though I’m sure if you looked back, you’d find plenty of examples of that sentiment before formula existed. Back in the day, a plump baby would have a higher survival rate, I expect.

WTELF? By the way, my N=1 example of combo and then EFF baby is consistently at 50th percentile of weight and almost 90th of height, so he’s anything but plump (except for cheeks and double chin). His oldest half brother (from husband’s first wife) was EBF and a textbook example of chubby baby.

anh

I’ve seen a double standard applied. The mother of chubby roly poly baby who is breastfeeding gets told “Great job mama!” but if that same child is formula fed a mother is cautioned. A woman on a board once told me it’s because breast milk causes fat cells to get bigger but formula causes fat cells to grow. It’s really awful.

Monkey Professor for a Head

Yup, my son went from 50th centile to 97th on breast milk alone, and I was told I was doing a great job. Which I found weird, because the ability to produce breastmilk isn’t exactly under conscious control.

Jules B

I actually saw the public health nurses/LC’s change their POV right in front of me – like literally in moments in front of my eyes they did a 180 – when I confessed to them at my daughter’s four month check-in/vaccinations that I was no longer EBF. They had been saying “good job!” and when I fessed up to the formula supplementing they started lecturing me about her not jumping up too much on the curve (btw, she was at the 60th for weight at that point so….?)

Nick Sanders

What exactly is supposed to be the difference between “getting bigger” and “growing”?

anh

I wrote that badly. They claimed that formula feeding created NEW fat cells but breast milk just made already existing fat cells get bigger. it was nonsensical.

Nick Sanders

I just assumed that those were their words, and they were just giving the usual nonsense.

MI Dawn

My EBF babies were rolypoly after they started gaining weight (36 and 35 weekers so they were skinny at birth). Both were in the 50-75 percentiles by their 4 week checkups. But, as I’ve said, I was lucky and I was a very good cow.

Daleth

My slightly preemie twins went from 30-40-somethingth percentile in their early days to 70%+ for weight and 90%+ for height on a diet of basically 90%-95% formula. Yay formula!

BeatriceC

To quote Bofa “All things equal, breast is best. Trouble is all things are never equal.” It’s so wonderful that we have formula to fill the need for moms and babies who need it!

The Bofa on the Sofa

We’re calling that “Bofa’s 2nd Law” now.

Amy M

My slightly preemie twins were in 3-5th percentile at birth for everything and still are now, at age 7. The basically 100% formula did not make them obese—clearly they are genetically tiny and would be regardless of diet.

demodocus

Whereas my preemie, bf’d self hasn’t been small for my age since preschool, and I’ve been obese since college.

BeatriceC

Moo. Move over fellow cow! I need to join you in the pasture. My sisters were also good cows. My niece was a good size newborn. 8 pounds and what ounces I can’t really (I think 10 oz, but don’t quote me). Then she got chunky. Like really, really chunky. She was the rolliest-polliest baby I’ve ever seen. She had at least 4 chins. These days she’s 24 and, like her mother (pre-pregnancy) 95 pounds soaking wet (and around 5’6″…there’s some skinny genes in my family I didn’t inherit).

My babies all grew very well. My oversupply was the stuff of legends, especially with the youngest.

The Bofa on the Sofa

My sister’s 2nd girl was EBF and weighed 26 lbs at 6 mos. I don’t think there is a percentile to describe that. She looked like the Michelin Man, including the rolls in her arms and legs.

She actually ended up 26 lbs at 1 year. So when not being EBF, she didn’t gain wait.

My sistrr’s third was only 22 lbs at 6 mo. Still well above average

EmbraceYourInnerCrone

Well my completely formula fed kid was rolly-polly when she was born (almost 9 lbs but short). She looked like the Buddha.
Fast forward 6 months and she was at about the 50th centile..did her pediatrician worry , nope. I am 5 ft nothing and until I hit my 30’s weighed less than 100 lbs. I was always the smallest kid in class( so was my mom, and her mom). Since the Spawn was crawling at 5 months, and healthy as a horse, her doc figured she was just naturally small and burning off everything she ate zooming around all day. Thank heavens for a pediatrician who looked at the whole picture before passing judgement.
She’s grown up now and still a tiny little thing ( I think she has the metabolism of a ferret..)

rh1985

My formula fed kid is so skinny. At 2 years old she was less than 25 pounds. She finally outgrew her 12-18M clothes recently only because she grew too tall for them.

In truth it’s probably genetics, but it drives me nuts how the lactivists say a chubby BF baby means mom is doing a great job, skinny BF baby is fine and low supply doesn’t exist. A skinny FF baby is clearly undernourished by that awful formula, and a chubby FF baby was overfed, shame on you!

Megan

My anecdote: Hubby is average height and weight and I am quite short though not especially skinny. Hubby was a huge baby but then became long and lean. I was average at birth but then dropped and stayed at 20th percentile. Our first daughter fed all breastmilk (mine and donor milk) for 6-7 months second daughter fed formula from day 2 with some breastmilk the first week. Both were big babies at birth. Both dropped to 20th percentile for weight and stayed that way shortly after. Its almost like genetics has something to do with it. Imagine that.

Rach

My partner is fairly tall and all lean muscle. He has to consciously eat to keep weight on and works really hard to gain weight. I’m short, and if I so much as look at cake the weight goes on. All three of our kids are formula fed. Master Eight was so chubby he had three (!) chin rolls. He’s now quite tall and very lean like his father. Master Two was also chubby, although not to the extent of his older brother. He is also tall for his age and thinning out, although I think he will be of a more solid build. Miss One is still chubby, although the thinnest of all three. I also have Master Nine, whose father is short and solid. He was chubby as a baby but is lean now too, although he is built more solidly than any of the other three.

Given that my partner and I are completely different heights, metabolisms etc. I expect that all of our children could be quite different in build and height.

Monkey Professor for a Head

In my mums group some women breastfeed, some formula feed, and some combo feed. All the babies are pretty similar in terms of chubbiness. The main exception I can think of is one little girl who was initially breast fed. She was a skinny little thing, and was falling off the growth chart. Once her mum switched to combo feeding, and then formula feeding she gained weight and looks so much healthier. I saw her yesterday and I thought she looked wonderful, really thriving. Her mum mentioned to me a little while back that her pumped milk was always really thin and watery, so I wonder if it just wasn’t of sufficient quality to fully nourish a growing baby.

And then there’s my chubby EBF monkey!

Inmara

The same here, I look at pictures with a skinny baby and feel guilty that I tried EBF even for those 3 weeks. He was not loosing weight, fortunately (then I would have supplemented right away) but gained it slowly and his growth curve dropped from 25th percentile to 10th. And nobody was pressuring me (except LC who reassured that weight gain is “enough”) but I still tried to establish EBF for some reason.

BeatriceC

It would be almost worth it to have another baby and formula feed him or her in order to:

1) Have said baby in a BFHI hospital
2) Refuse to breastfeed
3) Draw up paperwork for every nurse, LC, and doctor to sign every time they try to give me crap that says something along the lines of “I acknowledge that failure to feed the baby will result in either permanent harm or death, and am still unwilling to provide food for the baby in the form of formula.
4) Draw up another set of paperwork that states “I’m aware of the dangers of potential harm to a baby left in the care of an exhausted, medicated mother, and still refuse to provide a safe place for the baby while the mother rests. Additionally, I’m aware of the harm to the mother caused by inadequate rest and recovery time after a major physical ordeal. I am still refusing to provide a safe space for both mother and baby, in spite of my knowledge of potential harm.

Roadstergal

These two forms should be made into PDFs, so that the folk here can bring them to their own deliveries and/or give them to their friends.

BeatriceC

Maybe An Actual Attorney could help with the legalese. It would be all kinds of awesome if mothers started pushing back like that.

Jules B

I just quickly ran the general idea past the lawyer in family. He said it could work – in the sense that it would escalate your “case” very quickly within the hospital and they’d know not to mess with you. If women started doing that en mass, it might actually change things. Hm.

BeatriceC

My main objectives are two-fold. First, something like that is likely to get attention. Much like KoB said, they’ll know immediately not to fuck with me. Second is to create a paper trail. I can’t imagine any situation going beyond a formal complaint (investigated or not), but in the event of a tragedy, there’s clear evidence that the hospital’s policies are negligent. If enough women documented their treatment and filed formal complaints, then maybe things will start changing.

KeeperOfTheBooks

Exactly. As said elsewhere on this thread, hospitals are really, REALLY invested in having happy moms as patients because it increases the likelihood that mom (and spouse/partner, and babies, and mom’s friends, if she’s particularly happy) will go to that hospital.
When I had DD, a patient satisfaction/safety survey type person was in my room every day to make sure both that I was happy and that basic safety standards were being followed. It was a rather good idea on an institutional level, because this person didn’t work in OB per se; he was from another department. As a result, you could say something like “I’m worried that X is a fall risk” or “It took them two hours to get me my pain meds” without having to worry about catching flack from your nurse for the implied (or outright) criticism.
I expect they still have someone like that there, and plan on using him judiciously next time ’round. I suspect that hearing “I’m exhausted and worried that I might drop my baby, and pardon my language, but how the hell is this bassinet/bed setup considered even remotely safe?” often enough might light a fire under the higher-ups. Also, to be fair, from what I’ve heard this hospital has become rather less rabidly lactivist now that they’ve gotten their BFHI certification, so it may not even be much of an issue at all.

KeeperOfTheBooks

Heh. My plan also includes having FIL, an attorney with lots of kids and no tolerance for stupid, on speed-dial.
“Hi, FIL? Oh, baby’s doing well, thanks, cute as can be! The thing is, I haven’t slept in 48 hours, and I’m worried that I might drop him, but my nurse and her supervisor are refusing to take care of him for a couple of hours while I sleep because it might disrupt our non-existent breastfeeding relationship or keep me from bonding with him.”
*slight pause for extremely rude comments about the intelligence, or lack thereof, of whoever came up with that idea from the other end of the line*
“Yeah, no argument there. I’m at Large Regional Medical Center, and my nurse’s name is Lactivist Nutjob. I was wondering if you could–oh, your secretary’s already pulling up their legal department’s number. Awesome, thank you so much! See you in a month when you come out to meet him! Love you too!”
I know this is, sadly, not an option for everyone, but I have no problem whatsoever exploiting my resources in this case.

BeatriceC

My family are all college professors, engineers and scientists. Unfortunately, no actual medical doctors or lawyers.

Obnurse

Should the nurses need to contact social services in case you get tired on a newborn schedule at home and drop your baby?

Sue

As an OB nurse, you don’t think the immediate post-partum period – whether it follows a prolonged labor or a general anesthetic – is somewhat unique?

Obnurse

Mother’s are entertaining a room full of guests, there is usually a support person in the room with mom. Mom can rest and keep a sleeping baby in her room. If the baby stirs and wants to nurse, the baby is there to be nursed. If the baby stirs and wants a bottle mom or support person can feed a bottle. It sounds like common sense but MOST mothers do not know newborn feeding cues. Rooming in is intended to allow mothers to learn their newborns feedings cues—regardless of how their being fed. If they’re smacking their lips…they probably are hungry versus wanting a pacifier shoved in their mouths

Who?

Isn’t there a list of common feeding cues-you describe one there. Seems like an ideal thing to cover in antenatal classes, and quite appropriate for a wall chart.

You hardly need a baby with you day and night for that. And the neonate nurses would be all over feeding cues and could bring baby in, if necessary?

Mrobnurse

That doesn’t help a new mom who didn’t go to prenatal classes recognize feeding cues. Instead she thinks the baby is making cute smacking noises or the baby is turning it’s head with its mouth wide open because it’s amazed at the scenery. Seriously, it seems like common sense. But to new parents…a diaper change can take 30 minutes.

momofone

I’m curious about why you continue to work as an OB nurse. You seem quite annoyed by your patients.

Mrobnurse

Not at all! Our patients come in excited about baby friendly! I’m annoyed with those spreading fear to expectant mothers.

The Computer Ate My Nym

Our patients come in excited about baby friendly!

But do they leave that way?

Tokyobelle

He doesn’t care. So long as they are compliant and don’t question his authority during their brief stay. Once they leave, they’re not his problem.

Chi

How is it spreading fear to tell mothers that they still have a CHOICE?

That they still have the right to formula feed if that’s their choice.

That they have the right to ask for help so they can rest and recover from their ordeal?

That they have the right to be treated like a competent human being capable of making the decisions that are best for them and their family??

Because I’m sorry, the BFHI doesn’t do that. It locks formula away so mothers aren’t ‘tempted’ by it. It makes mothers, tired, drugged room in with their babies, almost guaranteeing that they’re going to be exhausted before they even go home.

How is that ‘friendly’????

momofone

And with new parents who take thirty minutes to change a diaper and have visitors. That’s the part that confuses me–you’re pissed that they have visitors, but you also want said visitors to do your job.

Charybdis

How is fear being spread?

theoriginalguest

Mrobnurse,
No one’s “spreading fear” by talking about how mothers hate the BFHI! These are actual patients talking about THEIR experiences with being bullied into breastfeeding, made to feel inadequate, etc, that you and a few others (guest, obnurse) are just dismissing! Thank God there is an OB like Dr. Teuter who is actually willing to talk about this nonsense that has made it’s way into our U.S. hospitals! As nurses, we really have no control! They can fire us if they really want to for going against the BFHI. Thank God there are patients that are willing to tell their stories! Ladies, start writing to the CEO of your hospitals! If you had a nursery, thank them for having a nursery in their hospital! If you were FORCED to keep your infant, give the CEO hell for not having a nursery. If you get a Press Gainey survey to evaluate your hospital stay, do the same thing. Tell them how thankful you were that your nurse was able to take your baby to the nursery. Or give them hell for making you keep your baby when you needed to recover at night! Hospitals are VERY concerned with patient satisfaction! If enough women start complaining, hopefully this BFHI will go away. Far, far away! And if you ever have a nurse like guest, obnurse, or mrobnurse, ask for a different nurse. You deserve a good nurse!

Megan

And what about those of us who are second (or more) time moms and know feeding cues but just want to get a night of rest (possibly after surgery) before we go home to multiple children where there will be no rest? These mothers are likely to also be the ones in the hospital with no support person because their partner is at home with the older children.

Who?

Exactly.

D/

Or what about the daughter having her first who even has her own LC-mother for the first 2 weeks to provide around the clock care for them? I encouraged sending the grandkid to the nursery between the night feedings to allow both of us to rest up for the sheer work of having just one newborn at home. No one in the house was living on more than naps for weeks, and I don’t mean just two weeks either!

Honestly if I had anything at this point in my life causing me the degree of sleep disruption as a newborn, I’d have to take a leave of absence from work.

KeeperOfTheBooks

At one point when DD was a baby, I had to sit down with DH and tell him firmly that I was no longer safe to drive, and wouldn’t be until she was sleeping better at night. (I did all the night wakings with her.) This was after I fell sound asleep while driving the 2 miles to the grocery store. Fortunately, I was at a red light, and equally fortunately, I was woken up by the driver behind me honking and not by rolling into someone/traffic, but…yeah. I was/am a SAHM, too; I have absolutely no idea how non-SAHMs handle that level of sleep deprivation plus the demands of a job, but they have my utmost respect for it.

Who?

Maybe all new ie first time mothers need a 10 minute session about what to look out for in a hungry/sleepy/fussy baby. Use the wall chart to demonstrate. Armed with the theory, then they can call for help if they need it.

How on earth with disposable nappies and wipes, and two adult parents of average intelligence, can a nappy change take half an hour? The worst that can happen is that the crookedly applied nappy leaks, creating washing. Hardly a surprise, let alone a catastrophe where a new baby is involved. And a wonderful learning opportunity.

Erin

My first nappy change was done to a baby in an incubator, so hands shoved through holes in the side. I was 24ish hours post csection, hadn’t slept, already started with my breakdown and it took me less than 5 minutes. 30 seems improbable in the extreme.

Nick Sanders

So making them sit in the same room while the baby does these things you’ve just said they don’t automatically recognize helps how?

rh1985

I had over ten years of childcare experience including several newborns before my daughter was born. I learned how to change a diaper and bottle feed a newborn before I was old enough to drive. What I needed was sleep so I would be sufficiently recovered to care for my daughter when we went home. I knew how to care for her. I just needed to recover my strength in the hospital so I’d be physically able to care for her at home. Since my hospital was decent and had a nursery, I was able to get the rest I needed.

momofone

I’m not a nurse, so forgive me for thinking this might work–what if, when you see feeding cues, you say to the parents, “These are feeding cues. The baby is letting you know s/he is hungry, and it’s probably easier to do that now than to wait until s/he’s crying and harder to settle.” Then you’ve offered them something useful, unlike “Maybe your VISITORS can help you figure this shit out.”

moto_librarian

Really? 30 minutes to change a diaper?

Monkey Professor for a Head

When I gave birth there was a chart like that in a folder at the end of every bed on the maternity ward.

Suzanne

I’m sorry, but that’s not universally true. I had a roommate with her entire screaming family there, but I had very few guests. For my second, my husband couldn’t just hang out because we had a another kid.

Daleth

The baby is there, sure, but can mom care for it? I certainly couldn’t after my c-section. I had pre-e and gained 60% of my pre-pregnancy body weight in pure fluids… I could barely move. It was a major accomplishment when 2 days after childbirth I was able, with only about 6 minutes of sustained effort, to drag myself out of bed and to the bathroom 5 feet away without having to wake my husband up to help.

Amazed

I could and did entertain a room full of guests when I was lying in bed with a broken foot. Thank God that there wasn’t a judgmental asshole like you around to tell me that I needed to do the laundry as well.

Those lazy “mother’s”! Entertaining guests but wanting a little reprieve after they had been through the possibly most taxing experience in their lives! How dare they!

guest

Laying in bed with a broken foot is MUCH different than laboring for hours. Get real. Go break a foot!

Charybdis

The only time I had a “roomful” of guests was the day of my CS. The rest of the time it was one, maybe two people at most. DH came after work, my mother came in the mornings and MIL usually popped in in the evenings. So, most of the time I was by myself, post CS with a newborn. Made use of the nursery as well, had no problems sending DS there so I could sleep.

Would you be so kind as to tell us where you are (state is fine, no need to be THAT precise) so that we can get the word out that there is a Obnurse out there with a MAJOR attitude problem? Forewarned is forearmed.

guest

Babies that simply “stir.” LOL. You clearly have very little experience with babies.

Sue

You DO get, don’t you, alleged “Obnurse”, that the visitors, and most support persons, aren’t there overnight?

And, in case you don’t know, a mother can get tired during the day, and nod off when the lights are low, and visitors have gone, and it;s quiet, AT NIGHT.

moto_librarian

Let’s see…I had exactly one visitor other than my husband after our first child was born – my FIL, who came to visit briefly the second day after our son was born. He was still in the NICU, and we could only see him briefly. I had two visitors with our second child – my older son, who came the day after his brother was born, and one friend, who came to visit for an hour. That’s it. I have no family that lives less than two hours from here. I needed to rest as much as possible while in the hospital precisely because my husband and I were going to be on our own when we came home from the hospital.

Chi

Except at home you’re more likely to have a partner or close family to help. Families and partners are limited to how much help they can provide in hospital because of limited visiting hours or tests being done etc etc etc.

At least at home you can call someone if you need help. And I would hope that by the time mothers are discharged, they know to put the baby in a safe space and call their well-child provider or a support person if they’re having trouble coping.

BeatriceC

Funny how that newborn schedule would be so much easier to manage if the mother was given a chance to rest in the immediate postpartum period. But since you’re not a real nurse, or medical professional, and you’re only able to parrot the worn-down tropes without actually thinking about what you’re saying, I hold no hope that you’d actually be able to think logically enough to figure out that a day or two of recovering after a major physical event is necessary for the long haul. And your “argument” about visitors is ridiculous, plus your patronizing attitude about the real, human, biological need for rest is horrifying. If by some weird chance you actually are a nurse, your license should be stripped and you should never, ever be allowed near patients.

Oh, and for the record, there has been no society anywhere in history that has left mothers to fend for themselves in the immediate postpartum period if it could at all be helped. With, I believe the exception of one small, short-lived tribe, every society in every time in history has provided support and recovery time to new mothers. The modern Western culture is the first one that has the ability to allow the mother to rest, but refuses.

KeeperOfTheBooks

Let’s take my last baby as an example.
I had a C-section because baby thought it would be a cool idea to come out transverse/breech, but my OB and I disagreed. As a result, I couldn’t get out of bed until almost 24 hours later due to a combination of the spinal anesthesia and the catheter. Baby was supposed to sleep in a bassinet next to the bed, but I couldn’t get in and out of bed to put her in there. The bassinet’s wheels didn’t lock, and I am short (though not unusually so–5’2″) enough that even with the bed at its utmost height, I could not reach to get her in or out of the bassinet, and even if I were 4-5″ taller and therefore able to reach, it wouldn’t have been safe because, again, non-locking wheels.
I saw my nurse twice each shift: once at start of shift, once at the end. The techs I saw a bit more frequently, but they were far too busy to come put DD into bed/take her out every time I needed that to happen.
I slept perhaps two hours the night before my C-section. After two days in the hospital, I’d still had almost no sleep. I did not have a support person to help. By the fourth day, I was about out of my mind from no sleep and a baby who never stopped screaming. I was, at that point, able to get out of bed, but I couldn’t get out of bed or into bed safely while holding her because I needed my arms to help me leverage in and out of bed. I nearly dropped her on the floor several times while trying to get in/out of bed while holding her because there was no one to help and because I didn’t have as good control of my legs as I do when I haven’t recently had a spinal.
We had visitors for a couple of hours one day, an hour the next day. These were DH’s coworkers, not the sort of people I could ask to help with newborn care. That’s it. No family in the area.
At home, on the other hand, I wasn’t on narcotics as I had been at the hospital, I’d healed up some from the major abdominal surgery and so was more able to stand up/get in and out of bed while holding a baby, and in any case, my bed at home is lower, enabling me to get in and out of it without having to rely as much on upper body strength. DD’s bassinet was low enough that I could place her in it or lift her out of it without getting out of bed. I was exhausted, sure, but I wasn’t exhausted plus dealing with post-anesthesia plus on narcotics plus in the ridiculous position of having to hold a newborn every time I got in and out of a rather tall bed when I didn’t have any sort of core muscles that could assist with that.

Nick Sanders

At home, one is expected to have a crib they can put the baby in, rather than making it sleep in one’s own bed.

rh1985

Once I got home, I:

1. Felt better, because I actually got a chance to rest and sleep in the hospital, and I was no longer in as much pain or taking so many strong painkillers. A few hours of sleep without interruption can make a big difference to a patient recovering from surgery (I had a c-section). Our nurses were great and cared for my baby at night so I could heal and be able to care for her when we went home.

2. Could more easily arrange for help so I could rest for a couple hours, because I had relatives happy to help at my house, but they weren’t willing to spend a night in the hospital room

3. Could sleep more easily while my baby was sleeping, because my bed was more comfortable, no one woke me up checking me, and I had my daughter in a separate room with a baby monitor at my bedside, so I woke up if she was awake and crying, but not if she made some little sounds in her sleep

guest

At home, I had less pain, because I had had a few days to recover. I had SPACE to arrange my babies and our paraphernalia in ways that works for us, so we weren’t always on top of each other the way we were in our tiny half of a hospital room. I had the ability to call on friends and family, and even paid professionals, to come and help when I needed it. Completely different scenario.

theoriginalguest

Alright obnurse, you’re another one who needs to pipe down and stop commenting on here! Any REAL OB RN knows that most women have support for awhile once they go home. We even ask our moms this question. If Dad’s working, most new moms have their mother, sister, cousin, a friend, someone who can help them! And no, these newborns are constantly in the same room as their mothers 24/7 once they get home usually. Usually there is someone who can take the infant downstairs and care for him/her while mom takes a nap. This is why the no nursery thing is so ridiculous anyway. Sending your baby to the nursery is just like sending your baby downstairs with a family member for a few hours so you can sleep! And after these poor moms get out of these BF hospitals, they’ll need to sleep for 24hrs straight to recuperate! We’re setting these poor women up for postpartum depression, even postpartum psychosis. We need to have empathy for our moms. And we are not in a thrid world country, were we have no choice but to keep our baby 24/7 after we deliver! You’re not an obnurse that I’d ever want, that’s for sure! I’m not convinced you’re a nurse either! Don’t make comments about things that you know nothing about!

Obnurse

Also, the law does not scare Healthcare providers who are practicing based on evidence-based World Health and UNICEF recommendations. All guidelines Healthcare providers use are evidence-based guidelines by some overseeing body.

The Computer Ate My Nym

“The law does not scare…” BWAHAHAHA! Sorry, but that statement makes me doubt your nym. Anyone who has worked in medicine knows that you can be sued for ANYTHING! And the person suing can win for anything, whether your care was evidence based or not. Heck, whether there was a bad outcome or not. Practicing using evidence based guidelines is helpful, but completely protective? Well, not in the US, at the very least.

Also, are you appropriately applying the guidelines? Is the patient in front of you an appropriate one to apply a given guideline to? I’m not an OB or pediatrician, but a classic example from internal medicine is the use of K sparing diuretics after an MI. Several studies showed decreased morbidity after an acute MI if K sparing diuretics were given. When this was applied to the general patient population, there was an increase in deaths due to hyperkalemia. Why? Because the studies were performed in people with perfect renal function and a large percentage of cardiac patients have secondary damage to their kidneys and can’t waste potassium appropriately. In short, the studies were correct but incomplete and the guidelines were applied inappropriately. Think that can’t possibly happen in your practice? I find it unlikely. Applying the guidelines without knowing why they are guidelines is a disaster in potentia.

Daleth

the law does not scare Healthcare providers who are practicing based on evidence-based World Health and UNICEF recommendations.

If you’re applying recommendations tailored for third-world community health centers to childbirth and postnatal care in American hospitals, you had better be damn scared of the law.

theoriginalguest

Amen! Yeah, we’re petrified of the law at our hospital!

BeatriceC

Except that they’re not. The WHO and UNICEF make recommendations for third world countries that are inappropriately applied to developed nations. The breastfeeding police have taken studies on preterm infants and inappropriately extrapolated the results to apply to term babies. The only studies that come close to controlling for all the major cofounders don’t find any substantiative difference between breastmilk and formula fed babies in developed countries with clean water. And then there’s the mother. Funny how the mother gets ignored in all this. Some women have easy labors and can easily care for a newborn 24/7 right from the start. Most don’t. It’s pure cruelty what hospitals are doing to mothers under the guise of “it’s best for the baby”. It’s not even best for the baby. It’s made up unicorn sparkles dressed up in pretty ruffles that people have bought into. The actual science says something very, very different.

I don’t believe for a second you’re a nurse at all, let alone an OB nurse. You’re simply too ignorant.

theoriginalguest

Here’s the thing that I don’t understand….How does upper management of these BF hospitals not understand how dangerous BF hospitals actually are? If an exhausted mother drops in infant because she fell asleep, you can’t say, “Well, our hospital is now BF, so we require all of our mothers to room in 24/7,” and have that be an acceptable answer for why you didn’t provide the care that this couplet needed! How any nurse doesn’t understand this as well, I don’t know! BF is just plain dangerous. All of our nurses understand this!

Erin

If I have another, that’s exactly what I’ll be doing. Even if I decide to try breastfeeding again (which I probably would assuming a slightly less unpleasant experience), I’d still want to supplement in the beginning and I don’t want to be a “positive” statistic for them.

Mac Sherbert

If you don’t want to do then don’t. However, if you’re interested I will tell you that nursing my 2nd baby was nothing like nursing 1st baby! 1st baby is was painful. I was horrible. It was well the worst thing ever (barracuda baby all the way). It was so bad that my own mother said she wasn’t coming to stay with me if I BF the next one. So it was a total surprise that 2nd baby had the most gentle latch. There was virtually no pain. She was also much more effective at getting milk and it would leak and run down her face as she passed out into a milk coma. Her latch and actually the advice I got hear made such a difference.

Nick Sanders

Now I’ve got the image of hundreds of babies doing this, searching for a boob:

That’s not dissimilar to my plans for Baby Books the Second, due in June. From what I hear, #3 shouldn’t be an issue (they aren’t complete morons), but #4 may be. Fortunately, I’m a lot more sure of myself this time, I have no qualms about saying “I need help,” and I have even fewer qualms about saying, “Right, then I need to speak to your supervisor and the hospital’s legal counsel. Immediately.”

queenofcoins

I am working on something similar currently. I am six months pregnant with #1. I have been reading Dr Amy’s awesome blog since we started TTC. All the local hospitals are not “Baby” Friendly but they have implemented many of the same things. So I am currently working on retaliation forms if they refuse to give me formula. I’ll be sneaking my own in because I don’t want to gamble with my baby’s health if they decide to be extra awful but I won’t let them know I have it so they will bring me some like they should.

I am known to have no tact and very willingly speak my mind when I see bulls***. I call it out with no worry to the feelings of others. I plan to exercise that skill at the hospital. Plus my husband is in the military, so hopefully dropping the word “JAG” a few times might help matters.

AA

Have you looked at the FB group ”

Breast milk is best, but only if you have breast milk.”? It has some sample feeding plans

Who?

Just take your own formual and give it to the baby if you want to. They’ll soon give you more if they see you using it and aren’t difficult. And if they are difficult, well, you’ve saved yourself an interaction you don’t need.

Honestly you’ll want to sleep/relax/whatever not engage with staff and petty bureaucrats, however inevitable/tempting the fight seems now. Sometimes, the fight you win, you lose.

queenofcoins

No, because if I give in, that gives them power over the next mother. I am not one to be passive, especially when my passivity gives them power to hurt others. I’m not selfish enough to only think of me in this situation, seeing how many mothers I have read about in the past 18 months or so have been treated so horribly. I’m going to make a stand if I need to.

Who?

It won’t help the next mother, will just make the petty bureaucrat/nurse grumpier, because they had a loss.

Their pay/credit at work might just depend on meeting whatever nonsense goals are set for them. An LC on here the other day was saying they are moving towards this at the hospital where she works.

The way to beat this is from the top-it’s taken a while to come in, it will take a while to get it slowed down then moved out again.

The people at the pointy end have no power.

Inmara

Sounds like a plan! I think I’ll implement something like this next time (not in the books yet but we have a vague plan to try for a second baby after some 2 years). I already know that my preference will be another hospital and I’ll be more vigilant to find out their postpartum care options beforehand and ask for well-baby nursery. If they refuse, I could shove such paperwork under their noses. With this baby I was so hormonal and exhausted I couldn’t argue when pediatrician basically blamed me for baby’s reflux and weight loss, but I hope that next time I’ll be more prepared.

Guest

Yeah, don’t expect a newborn nursery to magically appear just for you and your paperwork. They are getting rid of them. Which means not there. Have a home birth and ask your doula to stay the night.

Inmara

You advise to have a homebirth for a mom who’s worried about baby’s safety? Really?

FYI, I’m from a country where rooming-in has been mandatory for like two decades not because of some “baby-friendly” crap but because of shortages of funds and staff. Yet there are nurseries where they place babies of mothers who have literally passed out from blood loss and other complications, so if you insist you can have your baby taken care of for at least couple of hours. I didn’t know that the hospital floors are different in that matter; in mine there was just one midwife for like 20-30 moms/babies during the night, so she couldn’t help me even if she wanted. But on the other floor there is a nursery, so had I known that in advance (and that we won’t get family room and my husband will be restricted to visit between noon and 7 PM) I would have insisted to get sent to that floor.
I survived, and so did my roommates and their babies (including post-CS mom with inadequate pain relief) but I was endangering my baby at least couple of times, trying to nurse him/cosleep while almost passing out from exhaustion.

guest

They may not have a well baby nursery, but they will have some type of nursery for sick babies. So it’s not like there is no option to put the baby somewhere.

Charybdis

Uh, no. Not just no…but HELL TO THE NO! All the nope in the world.

No way I’m EVER having a home birth, nor hiring a doula.

How, exactly, is this plan better?

theoriginalguest

Wow, now guest is advising women to have home births with doulas (who have no real medical education most of the time). We’ve had doulas try to talk their patients out of and interfere with c-sections in our hospital! Who the hell is this person? Please disregard everything that guest says people! Ignore this person and maybe he/she will go away!

theoriginalguest

Again, sometimes it’sa c-section or dead baby, just like it’s formula or dead baby! Duolas don’t have the education to even be advising you on this stuff. They certainly can’t read fetal monitors. I HATE when we have a patient with a duola. We’ve seen patients bring two doulas before. Yeah, bring two people along with you who have no idea what they’re talking about to interfere with the care of you and your newborn. Two people who have no clue what they’re talking about is better than one! This child is only the most precious thing in your life! It’s insanity. You wouldn’t bring a duola along with you to a cardiac unit to dish out uneducated advice and try to talk you out of an angioplasty or bypass surgery would you? You wouldn’t have some doula advising you if you had cancer would you? So why the hell would your hire some uneducated person to help you through childbirth and with newborn care? Yes folks, if the hospital doesn’t offer a nursery, your best alternative is a home birth with a doula! Great advice! You can insist the nurse take your baby for a few hours so you can rest. Nurses will still do this for you, nursery or not! It’s their job! Leave the duolas for the lactivists! They can hire them! Stick with doctors and nurses folks. They will save your life in an emergency.

Daleth

I love your plan. I think I love you. 🙂

BeatriceC

lol. You made me smile today.

My tolerance for bullshit these days is at an all time low. If we give real facts about the very real risks, we’re fear mongering, but if the NCB crowd twists data, manipulates the truth, or just flat out lies they’re just “protecting” women. Bullshit. Really protecting women would mean treating us like adults with brains who can make decisions based on real data, and don’t need to be protected from the ugly truth. Because like it or not, the truth is ugly.

Jules B

Agree 100%. One of the biggest shocks for me when I went from being a working professional who was assumed (most of the time) to have a brain I could use to analyze/decide stuff on my own, to being “just a Mom,” was how suddenly people started treating me like my brain no longer worked. I was not expecting that.

theoriginalguest

BeatriceC,

I LOVE this and I’ve been a postpartum nurse for many, many years! I’d LOVE a patient to show up with papers like this! It would completely make us look as ridiculous as we are with the stupid BFHI. We’re working towards the BFHI and all of our staff thinks it’s complete BS. If we actually are certified as BF, our staff will absolutely break the rules for our moms as much as we can. This is what nursing is all about after all, doing what’s best for each INDIVIDUAL patient, not bullying people into doing what we want them to do! I do shutter to think what our hospital might become if we do in fact become BF. We will reminisce about the days when we used to give such good care! It’s very very sad! It’s funny how our LC’s (some of them aren’t even nurses) are NO WHERE to be found in the middle of the night when our babies are screaming their heads off and our moms are having their meltdowns. Even if they were there, they couldn’t wave their magic lactation wands and make these moms produce enough milk for their newborns on day 2 of life! Stop the insanity already! It’s NOT about YOU lactivists! I have yet to understand why these people are so invested and care so much in what other people do! How does it even affect them? With some women, it’s formula or a dead baby! STOP making them feel guilty about what they have NO CONTROL over! Stop making our moms feel like bad mothers on day 2 of their infants’ lives. I’m theoriginalguest, the one who posted the first comment on this article. Not the one who’s posting comments that’s making everyone angry and citing Unicef!

Dr Kitty

My almost 8month old son had his developmental check this week. Where I live this means a Health Visitor coming to your house to weigh the baby, have a chat with you and address any concerns.

My kiddo was 9th centile at birth for length and weight. He’s now 50th centile for length and 25th for weight. He crawled across the floor, tried to eat her shoes, smiled at her and rolled off the scales when she tried to weigh him.

I don’t think the 8oz of formula he has got every day for the last month has done him any harm.

MI Dawn

I’m so glad I had my kids before all this! As a breastfeeder, I was a wonderful cow…milk came in on day 2 and I leaked like crazy. I was delighted to be in the hospital and let THEM deal with the laundry of my soaked-through gowns.

That being said – I started both kids on bottles at 5 weeks, in preparation for returning to work. I pumped when I could, gave formula when I couldn’t. They never had nipple confusion. Eventually (due to ear infections), both developed nipple *preference* as a bottle was much easier to nurse from and much less painful.

However, if my children ever have kids, how they feed is up to them, and I’ll happily smuggle formula if needed, support EBF if desired, or EFF, or combo. As long as the baby is happy and mama is happy, who cares HOW they get their nutrition? And I’ll be there to let mama get sleep in and out of the hospital for a while.

(Note, however, that steak and potatoes will not be offered until baby can gum them efficiently).

BeatriceC

I had my kids just as things were starting to go bad. The hospital I delivered the youngest two at didn’t have a well baby nursery, but that was irrelevant to me, as they were preemies and went to the NICU. Honestly, I don’t know how I would have handled it. I really needed to rest and recover, and I was able to do so, but how would things have turned out if I had healthy kids?

Also, the NIUC nurses called me Bessie (in a friendly, teasing sort of way), because of the volume of milk I produced that came in about 10-12 hours after birth, then really got bad on day 2. But again, since they were preemies, they weren’t nursing directly from the breast at that point, so the latching thing wasn’t relevant. The oldest did get put to the breast on day 2 (TPN before that), and I’ve described before how that went. But again, NICU does things very, very differently. I was upset about the trouble learning to latch, and my mother convinced me that it was okay to use a little formula, and the NICU nurses were totally fine with that.

Obnurse

It would have turned out just fine. Parents are being educated at prenatal appointments that nursing staff will not take babies to the nursery and to have a support person available—-friend, father of the baby, mother, sister, etc. to help. Mom’s are going home at 24-r8 hours nowadays. C section mom’s USED TO lay in bed for 5 days!!! Then, research showed mothers were dying at an alarming rate from blood clots. Now, c section mom’s are up and walking by 12 hours and home within 48-72 hours and the rate of death by blood clots is significantly low. Everyone panicked about that and it has been best for mothers! Take a chill pill, let mothers trust their bodys for what they were made to do and if they need a back up plan Healthcare providers are there to SUPPORT them. Get updated on the evidence based research behind this before you go spreading your fear mongering like a terrorist.

Sue

“let mothers trust their bodys for what they were made to do”

“Get updated on the evidence based research behind this before you go spreading your fear mongering like a terrorist.”

Oh. My. Goodness.

Is this an actual health care provider?

Obnurse

What are your concerns with those statements?

If you eat a bag of candy, you trust your body to make insulin so that your blood sugar levels do not rise.

If you nurse a baby, you trust your body to release prolactin and oxytocin in order to provide colostrum or mature milk.

What is the difference?

Inmara

Seriously? You are a healthcare professional and use the phrase “trust your body”? SMH

The Computer Ate My Nym

Seriously? A supposed health care provider using insulin production as an example of how the body is trustworthy? Are you just trolling us or what?

Who?

Well, unless you happen to be diabetic.

And in that case, all that happens is you get sick. If the body attempting the breastfeeding breaks trust, the baby goes hungry, then starves. The baby is a conscript in this scenario, not a volunteer who signed up to participate in an experiment.

Monkey Professor for a Head

#Trustbetacells

The Computer Ate My Nym

Huh. I’d sooner trust a politician than trust a pancreas.

anh

there is no way you are an ob nurse. If you were you’d be aware of how often this simple process you describe doesn’t work. Or maybe since you kick women out of the hospital so early you don’t see how things to go hell when she’s discharged 24 hours post partum.
In any case, if you are really an ob nurse, stick around this blog and listen to the stories of women and babies who are harmed by these policies. We are not making it up.

Linden

And those two examples of biological feedback systems NEVER FAIL. Nobody dies because their blood sugar goes out of whack. No baby has issues due to insufficient milk.
Are you sure you have a nursing degree?

Sue

What are my concerns? The apparent lack of understanding of how the body works – from a health care provider.

A trained health care provider is aware that health has nothing to do with “trust” – obstetric emergencies can, and do, happen without warning.

Trusting that your body will not become insulin resistent will not prevent diabetes.

So, you are right – there is no difference. “Trust” is inappropriate in both instances.

Then, the second comment. Dr Amy and many commenters are are FAR further across the research than you appear to be.

And “fear mongering like a terrorist”? Spare me.

Finally, not knowing how to construct a simple plural in English adds insult to injury.

Linden

Wow, visitors should be banned, but these banned people should somehow be supporting the baby in hospital? What should women without support people do? How about single mums?

MaineJen

…Terrorist?

Really, dude?

Linden

Obnurse credibility=0

Megan

So you can’t spell and you call us terrorists but we’re supposed to believe you passed the NCLEX? Sure…

Charybdis

So parents are being “educated” during prenatal appointments that they are expected to have a support person with them IN THE HOSPITAL 24/7? What exactly does that promote?

If it is this way, then why the hell are people like you there to begin with? I mean, if *anyone* can do your job for free, then why are the hospitals paying you and your fellow nurses to be there at all? Think of the savings!

BeatriceC

So you were one of my postpartum nurses? You know exactly what was going on so you can say with confidence that it would have all been okay?

The rest of your post is flat out wrong. You plucked numbers out of nowhere. The evidence actually shows that mothers are going home too soon, but since some mothers are recovered well enough that early, insurance companies are sending them packing. It’s money thing, not a medical care thing. C-sections have better outcomes because surgical technique is better. Walking around the ward is very different from caring for a newborn you’re technically not even allowed to pick up. Once again, you show how much you really don’t know.

Nick Sanders

Parents are being educated at prenatal appointments that nursing staff will not take babies to the nursery and to have a support person available

Well, fuck you too, then. What about single moms? OR women whose partners simply can’t be there for whatever reason – on military deployment, out of town when early labor started, barely making enough money to scrape so can’t take time off work, etc.?

Don’t forget the mother who reported here a few months back that her BFHI hospital would only allow the baby’s father to spend the night, regardless of the family situation. If I recall correctly, that person was a military wife and her husband was in Iraq or Afghanistan, and she wanted her mother to stay with her but the hospital would not allow it because “only the baby’s father” because “family” or something.

guest

My hospital did forced rooming in and only allowed affluent families to have an overnight guest. No, really. Private rooms had to be paid for, $300/night. Otherwise, you shared a room and no overnight guests were allowed, period. And there was no well-baby nursery.

So on the one hand, I’m pretty sure you could have any one person you liked stay overnight in your private room. But on the other hand, this was something only families with spending cash could have.

Sue

Imagine the backlash if post-operative patients were told that nurses would no longer administer medications or change dressings – it patients wanted this to happen, they would have to have a 24 hour “support person”.

guest

Not every mother has a support person. What are they to do? You can’t simply “advise” such a person into existence!

theoriginalguest

Exactly, this is an argument we always make with the 24/7 rooming in being mandatory. These lactivists live in la la land where everyone has adequate support and all breasts make an abundance of milk! Real life isn’t like this! Some women have a not so very nice or an abusive support person too! And our primary goal is the mother and baby’s safety, not breastfeeding

guest

I was a single mother having twins. If they had not gone to the NICU, my hospital would have forced rooming in. It was a good thing that they were premature and went to the NICU. I was a single mother with more resources than most, and it’s just maddening that in a city with high poverty levels, this is how they treat women.

Who?

Is this the same classes they aren’t going to to learn about feeding cues?

Terrorists are fearmongering, are they? Around here it is politicians fearmongering based on the acts of a few crazed individuals identified as (not, ‘identifying as’) terrorists. As a fear mongerer yourself, perhaps that distinction is a little subtle for you.

AnnaPDE

Have you tried getting up 12 hours after abdominal surgery? Even with a lot of pain relief, I couldn’t stand for longer than a few seconds without serious ripping/tearing pain at the incision, for about a week. Sitting upright was bad enough in the first days.
Add to this a bed with raised sides that you can only lower while basically hanging over them head-down, and no handholds to get up without using your abs full-on, but a bassinet that is too high to reach otherwise, and there you have a person who is just not physically able to handle baby care by herself safely. Visitors are a help there.
You have clearly no idea what you’re writing about in this patronising way, and it shows by the pure BS it’s resulting in.

demodocus

Considering I was on magnesium sulfate for my kid’s first 24 hours and I quite literally have no memories of his first night, I’m sure i’d have been perfectly safe for all the baby care. Not only this, but my husband had been up effectively for 40 hours, and woke up every time a staff member came into the room ’cause he was sleeping in a chair, i’m sure he’d been great, too. Fortunately, our ob nurses were pretty darn helpful.

guest

You are all a bunch of idiots. Every time before you eat, all throughout the day are you having anxiety that your pancreas will fail you? NO! BUT MOTHER’S ARE FEARING THEIR BODY WILL NOT WORK! THAT THEY WILL NOT BE ABLE TO MAKE MILK because of blogs like this, people like you. They need support. They need to trust their body and be aware that their could be instances of needing to alter something…but until then they need to not be full of doubt from others. What is it that makes you all so negative against breastfeeding and supporting breastfeeding mothers? It is terribly sad that 80% of American women are initiating breastfeeding after birth but only 20% are still breastfeeding at 3 months. The main reason they quit, lack of support, lack of positivity. People like each of you.

momofone

What about people whose bodies have already failed them, perhaps multiple times, before they give birth? People who, for example, dealt with infertility to get pregnant in the first place? It doesn’t always work, no matter how much sunshine you push.

Edited to add that I’m a huge supporter of breastfeeding for women who want to do it. I did it for almost two years. I still could not care less how anyone else wants to feed his or her baby. I support FEEDING mothers, however that happens.

Chi

Wow. The hubris is ASTOUNDING!

Do YOU know why mothers quit breastfeeding?

It’s not just because of lack of support. There are SEVERAL reasons mothers stop breastfeeding.

1) Inability to produce milk. This happens in 5-15% of mothers despite how you lactivists try to twist the numbers. And a positive attitude will not magically make a mother produce more milk, no matter what you believe.

2) They have to go back to work. Some families simply CANNOT survive on one income. If you want women to breastfeed for longer than 3 months, start lobbying for longer paid maternity leave.

3) They are suffering from postpartum depression and need to go on medication that isn’t compatible with breastfeeding.

4) They just don’t like it! And that’s their CHOICE.

Who the hell are you to judge? You have no idea why each mother stopped.

You’re the idiot because you seem determined to push your ideology regardless of what people have told you about their own personal experiences with both the BFHI and breastfeeding in general.

Who?

Why is it ‘sad’? I can see if you believe that one or two fewer colds and upset tummies are a catastrophe, that is a good reason to push on with breastfeeding.

But if women find they can’t, or don’t want to, or that it doesn’t suit them, why is that sad?

And while I’m here, can you name one other bodily function that is improved by ‘believing’ in it?

Nick Sanders

Every time before you eat, all throughout the day are you having anxiety that your pancreas will fail you?

I have Type 2 Diabetes, so maybe not every time, but I do worry about it.

They need support. They need to trust their body and be aware that their could be instances of needing to alter something…but until then they need to not be full of doubt from others.

To continue your comparison, no about of support or “trusting my body” will keep my blood sugar stable, but a bit of concern will keep me alert to the first signs of trouble.

What is it that makes you all so negative against breastfeeding and supporting breastfeeding mothers?

Not one of us is. What we are against is the people pushing the line of “unmedicated vaginal birth, sleep with your baby from day 1, and exclusive breast feeding or you’re a failure as a mother”.

It is terribly sad that 80% of American women are initiating breastfeeding after birth but only 20% are still breastfeeding at 3 months.

Why? What difference does it make in the long run?

The main reason they quit, lack of support, lack of positivity. People like each of you.

That’s a bizarre thing to say to so many people who have said things like “a few mLs of formula during the first few days until my baby was strong enough to latch helped me BF for the next several months”.

BeatriceC

“The main reason they quit, lack of support, lack of positivity.”

Citation needed. Otherwise, this is the post of a rambling idiot pulling numbers and illogical analogies out of his nether regions.

Erin

I had a great supply almost from the outset and my son had a great latch. I quit after 3 months and with hindsight I should never have started.

I had support, I was surrounded by people who were breastfeeding or who had breastfed but none of that changed how I felt about doing it.

Every time I put my son to the breast, I was right back with my rapist’s mouth there. I could feel my heart rate rise, feel the panic but I listened to the lies of people like you who told me it was the only way I’d bond, that because my pelvis sucks and he was born by emcs that I had to make it up to him and that it would get better with time.
It didn’t. It made me hate him, not bond with him. I’d lie there telling myself he wasn’t hungry, he was crying for some other random reason. Then after a few minutes the guilt would catch up with me and I’d feed him with tears streaming down my face, planning on how best to kill myself.

I was diagnosed with PTSD (from the rape and reliving it during his arrival) and PnD 7 weeks after he was born. I was offered anti depressants until they discovered I was still breastfeeding and then I was told I could only have therapy instead. Apparently breastfeeding should fix the PnD and the flashbacks…(never got shown the citations for that either).

I’m not American but please explain what kind of “support and positivity” you would offer women like me or are you with the Midwife who told me “I shouldn’t have got pregnant if I wasn’t over being raped” (ignoring the fact that I thought I was over it until unfortunate circumstances brought it all back)?

There are an awful lot of shades of grey in breastfeeding and to ignore that, to make assumptions that everything from low or non existent supply to personal reasons in the case of sexual abuse/rape survivors can be fixed by breastfeeding support is insulting, damaging and downright stupid.

Inmara

Except there are people who KNOW before each meal that their pancreas will fail and thus take precautions diet-wise and administer insulin. Also, there are people who discover during their lifetime that their pancreas is failing, and they get properly diagnosed and advised on diet and medicine. And there are women who discover during pregnancy that their placental hormones have messed up and they have gestational diabetes, putting baby at risk if not taken seriously. In no hospital would all these people be advised to “trust their body” and “try harder”, yet somehow it’s acceptable to not test rigorously whether baby gets enough milk, risk serious health problems by not supplementing if there are signs of insufficient supply and bully mothers who question the whole “try harder” narrative.

Who?

Unfortunately there are those who encourage women to not take the GD tests that are available, or tell them how to fudge the results.

Our guest is sad not that some babies get underfed, but that some random ‘standard’ is not met.

momofone

It just occurred to me that I have been completely unsupportive of a friend of mine who has polycystic kidney disease. She is in the process of trying to find a donor, and I have supported her in that process. All this time I should have been telling her to trust her body! I should explain to her that her body wouldn’t grow a kidney that couldn’t filter waste instead of supporting the easy way out–ditching them and getting a new one.

Monkey Professor for a Head

If, in the weeks after my son was born, my pancreas had a 5-15% chance of failing me (hell, even if it was just a 1% risk), then yes, I’d be pretty worried. If I thought that my pancreas failing me would harm my son, then I’d be even more worried.

Which is why I have had an unopened tin of formula in my cupboard for the last 10 months. I sent my husband to buy it when I left hospital just in case. I didn’t need it in the end, but if I had any suspicion that my son was not getting enough breastmilk then I would have used it. The thought of my son not getting adequate nutrition was not acceptable to me.

Azuran

Not a really good analogy you have there. You follow the lead of all lactivist who think that anything other then ‘try harder, everyone can do it’ is not support and is hurting women.
When something is potentially hard and painful and might not work, proper support is to tell people it can be hard, painful and might not work. And then, when there are difficulties, try to find solution adapted to whatever problems the woman is facing. And yes, formula can be the answer and there is no shame in that.

Telling women that everyone can breastfeed, that it’s convenient for everyone, that is doesn’t hurt when you are doing it right and that it’s the most wonderful thing in the world is not support. It’s lies and it’s setting women up for failure.

Charybdis

Whether or not the mother’s body will make milk or not has exactly *diddly-squat* to do with her “believing in and/or trusting her body to make milk.” Just like if you are pregnant, but don’t believe that you are, just the act of believing you aren’t pregnant, that your period is just late, that taking that couple of BC pills later than usual can’t have mattered, that those antibiotics can’t interfere with the BC pill, WILL NOT MAKE YOU NOT PREGNANT NOR WILL YOUR PERIOD SHOW UP SIMPLY BECAUSE YOU DON’T BELIEVE YOU ARE PREGNANT.

We are NOT opposed to breastfeeding nor breastfeeding mothers. We do understand that there are things that can help breastfeeding be more successful (checking latches, different holds, extra pumping, etc). But what IS harming women and babies is the party line that states: breastfeeding is easy, always works, that very, very few women don’t make enough milk, babies don’t get hungry and/or that the amount of milk the mother makes is ALWAYS sufficient for and magically tailored to their baby from minute to minute and day to day, that the mother absolutely cannot do anything else but lay skin to skin with their baby and nurse, nurse, nurse. Also, the rhetoric that states that the baby will not have a poor latch, a shallow latch, weak suck, uncoordinated suck-and-swallow, or that the baby does not want to nurse, is just as bad. Oh, and that *all* nursing issues can be resolved by clipping tongue and lip ties, having the mother take handfuls of herbs and/or medications to boost supply and do nothing but attach a baby to her breast for eternity is also misleading at best and outright lying/manipulating at worst.

Many here have breastfeed and loved it. Many were “meh” about it; it was a way to feed the baby, they could have taken it or left it, but it worked for them and their situation, but it didn’t blow their skirt up. Some pumped and bottle fed because they did not want to be the *only* person to feed the baby. Some did it, disliked it, but kept at it because it was more economical for them and some, like me, outright hated, loathed and despised it and quit. I guarantee you, if someone had insinuated that I wasn’t trying “hard enough” and just needed more “education, support, and encouragement”, would have had a rage stroke or become very, very shouty and stabby. PPD is a bitch, and so was I.

Here is where I would like to refer you to Bofa’s Law: Breast is best, all things being equal; but things are not equal. Ever. It is people like you who do not seek to understand the individual woman’s circumstances, ever, before starting in with your shaming and propaganda that give breastfeeding a bad name. The combo feeders and EFF folks have never judged, browbeat, belittled or outright shamed a breastfeeding mother. You lactivists do not extend others the same courtesy.

theoriginalguest

Yes, we all know that just “trusting” in your body makes everything work out just fine! You wouldn’t get cancer if you just “trusted that you wouldn’t get cancer”. We have some of these poor women going back to work in 6 weeks. If they can’t continue to breastfeed, it isn’t just because they didn’t “trust in their bodies”. There is SOOOOOOO much more to whether these women continue to breastfeed or not that you know NOTHING about! You make things so black and white, when life is really just shades of gray! So if 80% of women start breastfeeding in the hospital, that’s 80% of babies that get the colostrum! I think that’s great! Stop putting these women down! If they can’t continue to breasteed, for whatever reason, it’s really none of your damn business! And YOU should have nothing to say about it! It’s a very personal decision. How about the fact that up to 15% of women will not produce enough milk for their infants even though they desperately want to exclusively breastfeed? This is why there’s formula available to supplement after breastfeedings! But if they just “trusted in their bodies” more or “willed their breasts” to make more milk, everything would be just fine! Just believe everything will be fine and it will all be fine! Boy, I wish that our bodies functioned with such simplicity! This mentality is a HUGE problem these days. Some women truly believe in this stuff. Hence the reason we have BFHI to begin with! If you just believe that you can have an unmedicated, vaginal birth, you will! Never mind that the infant is 10 pounds, and you would have died trying to deliver vaginally! A dead mom can’t breastfeed a baby, and you can’t breastfeed a dead baby! Safety first! So keep calling everyone a bunch of idiots! That’s a very professional thing for an OB nurse to do! I think they should start teaching your philosophy in medical schools and nursing schools. If you just “believe” that your body will work as intended, it will! No one would ever need to go to nursing or medical school then! It would all be very simple! Thanks for enlightening us guest! Any of us who’ve EVER had a serious illness know that our bodies don’t always work as intended, no matter how much we want them to! I can’t believe that a nurse would even make such a stupid comment!

theoriginalguest

I really hope you’re teaching lactation classes because your advice is so realistic and oh so helpful! I hope you know that people with your philosophy are pushing women NOT to breastfeed even more! You think you’re getting more women to breastfeed, but you’re not! Women have been walked all over, bullied, treated as less than human since the beginning of time. We’re finally starting to make progress with women have choices and doing what’s best for them. Then bam, we’re right back where we came from with people like you shoving your agendas down women’s throats! You’re making women hate breastfeeding instead of encouraging breastfeeding! I’ve personally SEEN it with my patients. They use the words bullies and nipple nazis to describe people like you! Straight from their mouths honey!

guest

EVERYBODY SMILE BECAUSE EVERYTHING IS RIGHT IN THE WORLD. POSITIVITY HOORAY, WE FIXED THE UNIVERSE!

demodocus

trusting your body doesn’t mean you won’t get pre-eclampsia. Or that your milk will come in sooner rather than later, or that you bleed so much you wonder how much blood is bad for your baby to eat.

Tiffany Aching

“Every time before you eat, all throughout the day are you having anxiety that your pancreas will fail you? ”

Well, maybe people with diabetes do ; at least they probably would if they were told to “trust their pancreas” and “try harder” instead of being given insulin. Which is exactly what lactivists do when they deny mothers with a low supply formula.

moto_librarian

My body doesn’t make milk, asshole. I had primary lactation failure after both of my deliveries. I tried the round-the-clock pumping regime. It did nothing. I have never experienced engorgement or let-down. I never pumped more than 1/2 an oz (and that was after 30-40 minutes of pumping from both breasts). When I quit pumping, I had no pain at all. If I had trusted my body, my sons would have starved to death.

American women do not have universal paid maternity leave. An astonishing number of women go back to work within two weeks of giving birth, and yet your primary concern is breastfeeding? Your priorities are ridiculously out of whack.

Madtowngirl

Nobody here is against breastfeeding or breastfeeding support. We are against the backhanded bullshit that masquerades as support, but is really about forcing mothers to breastfeed “at all costs.”

theadequatemother

I agree completely. The hospital I gave birth in isn’t baby friendly but is trying to “achieve” the designation. With my first I assumed things would work and I was told by the lactation consultants that the latch was good. And then we went home and I looked at my kid, who wasn’t screaming, with my anesthesia eyes on day two of life and I saw a baby who was dehydrated. I saw a baby that I would have given a bolus of fluid to before induction of general anesthesia and I saw a baby that looked like he had liver failure (jaundice). His breath smelled like ketones which is a particular smell that people get when they are starving. Our GP looked at him and even though he wasn’t jaundiced enough, and hadn’t lost enough weight she told me to feed him and gave me some RTF formula from her sample stash.

With kid number two I repeated that experience but without waiting until day two. I supplemented that kid from the get go until milk came in on day three. But I smuggled formula into the hospital and buried it in the trash after so I wouldn’t have to deal with a lecture.

That kid was intermediate risk range for bilirubin and the nurse told me that the pediatrician wanted a follow up Bili. I said I’d just supplement and everyone looked relived and relaxed and we weren’t called back for testing. It boggles my mind that the health system would rather bring babies in for visits and heal sticks and light therapy that could all be avoided if we just FED them. What kind of care is this that the parents of an infant who is at risk for kernicterus and brain damage can’t be TOLD to supplement because of some absolutely stupid arbitrary and meaningless breastfeeding rate goal?

I have a good relationship with the VP of patient safety and experience here. I have talked his ear off about the baby unfriendly initiative. Sent him articles of the dangers of not counselling supplementation wrt readmission and jaundice, and also the reports of skull fractures from tired parents dropping infants and accidental smotherings. But you just can’t convince the woman spearheading this bfhi – she is so convinced it’s good for women and babies and since everyone knows that BF is “good” the drive to achieve designation continues.

Roadstergal

“But you just can’t convince the woman spearheading this bfhi ”

Can you convince the parents of harmed babies to sue the BFHI accrediting body as well as the hospital?

BeatriceC

I’m not a very sue-happy person, but I seriously wish that some of these parents would start suing. I think hospitals are only going to change procedures when it starts hitting them in the wallet.

Roadstergal

Ditto ditto. It’s certainly a way to effect change. If lawsuits from all aspects of the BFHI – from forced-rooming-in to formula denial – start getting traction, that seems to now be the only way to make it look less appealing.

BeatriceC

I’m waiting for the mothers to start suing for malpractice because they’re forced to room in without relief. Those policies certainly are hurting the mothers as well as the babies.

moto_librarian

If one of my sons had smothered to death because I was too tired after delivery to care for them, I would absolutely sue the hospital. These aren’t random accidents – they are the clear result of expecting exhausted, ill mothers to care for vulnerable newborns.

Mac Sherbert

I really don’t understand this forced rooming in. I know one night I got mean (just because I was sleep deprived) the nurse realized what was happening and took the baby for the nursery for a “few” minutes for some “test”. I fell asleep and requested the baby back when I woke up a few hours later. I guess the woo crowd would have been mad at her, but really I needed the rest.

When my mom had me she was in the room with another mother that couldn’t even hold the baby. My mom thinks she had Postpartum or something. She had to go save the baby and when the nurses came to the room they tried to give it back to the Mom at which point my informed that was stupid unless they wanted a dead baby.

BeatriceC

I’m glad that nurse was there for you, but it’s pathetic that they have to lie in order to do what’s best for mothers and babies.

Obnurse

Maybe you should research the World Health Organization and Unicef’s research and rationale on it then.

Sue

Ms or Mr OB nurse – could you please go through the evidence for us, specifically for developed countries?

Mrobnurse

Take a look at the health in developed Scandinavian countries and their practices. They’ve been baby friendly for years!!

Then take a look at the health in America and our practices. Once again, we’re behind at least 150 countries.

We are a fat, unhealthy country for many reasons. Our children have more health problems than anywhere else in the world (if you exclude parasitic and sanitation diseases). Wake up!!!

Chi

Except no credible studies have linked breastfeeding with lack of obesity in later life.

And there is NO research that shows that forced rooming in does ANYTHING to improve breastfeeding rates. Because after women are discharged, they are more likely to stop.

So what then? Why make tired, drugged and sore mothers suffer just for this ideaology that breast is best?

The Computer Ate My Nym

Not to mention that the evidence that mild obesity is dangerous is actually pretty shaky. Observed mortality is a J-shaped curve with the lowest mortality in the “overweight” category. No one seems to quite know what to do with this information yet since it’s also clear that being overweight increases the risk of a number of chronic conditions, but it does suggest that the “but your kids will be fat if you don’t do X, Y, or Z” hysteria overestimates the importance of that outcome. Even if there is an actual link, which, for breast feeding, it appears that there is not.

Monkey Professor for a Head

Rooming in nearly scuppered breastfeeding for me. I had a rough time post delivery – 23 hour labour which started in the middle of the night, and then a significant PPH, which required a blood transfusion 36 hours post delivery. I was badly sleep deprived, and then had to care for a newborn at night on my own as we were not allowed to have visitors after 8pm. My son was (and still is) a ravenous little monkey and latched on frantically, and because I was so desperate to get him fed so I could sleep, I suffered through a painful latch instead of working to correct it. I ended up with very painful nipples – so much so that the first night at home, I hand expressed and we syringe fed all night because I couldn’t take the pain anymore and I needed my nipples to heal. Breastfeeding worked out in the end, but a few hours of uninterrupted sleep would have made everything go much more smoothly.

The Computer Ate My Nym

Then take a look at the health in America and our practices. Once again, we’re behind at least 150 countries.

What exactly do you mean by that? Behind in what way? What metrics are worse in the US than in 150 other countries?

Inmara

Not to mention that Scandinavia has one of strongest social security systems of the world, including maternity leave, unemployment benefits, available healthcare etc. But it has nothing to do with their longevity and health stats, it’s all due to mandatory rooming in! /s

The Computer Ate My Nym

And the mandatory part of the rooming in is at least somewhat dubious in Scandinavian countries. At least, the papers I’ve seen on a very brief review seem to talk about facilitating rooming in while also making help available for women who are too tired to care for their newborns or just want a brief break. Again, I just took a quick look at the literature and have no first hand experience with neonatal care in Scandinavia and so my impression could easily be wrong, but it sounded to me like the usual standard of care was having both options available.

Sue

Touche’, Inmara.

Sue

Wow – “wake up”? That certainly woke me!

I was looking for evidence that the specific practices implemented in US hospitals have improved outcomes.

Is there any?

theoriginalguest

This is what is so ridiculous. The BFHI has been around since the 90’s and it has NOT increased breastfeeding rates, even in hospitals officially designated as BF! Exclusive (this is the key exclusive) breastfeeding rates still remain about 50-60% in mothers that are discharged. I have actually looked at these figures. And no, I’m not wasting my time finding it again to post it to convince people that don’t even live in our country! Even in hospitals where there is 100% rooming-in, breastfeeding is not increasing! So that tells you right there that breastfeeding success has NOTHING to do with rooming in! It’s so much more complicated than just forcing mothers to room in! The data is available though. Hospitals have released breastfeeding rates.

BeatriceC

Actually, I’d hypothesize that when the numbers are truly analyzed, BFHI probably causes a net decrease in exclusive breastfeeding rates. We know for sure that exhausted mothers aren’t as likely to keep breastfeeding, and we also know that early supplementation actually increases long term breastfeeding rates, yet BFHI actively works against supplementation and contributes significantly to the exhaustion of mothers.

MI Dawn

Right. And I’ll room in 24/7 with my baby while I’m under seizure watch for severe pre-eclampsia, no nurses to keep an eye on me and the baby, and just breastfeed. Sure, MgSO4 makes you sleepy and decreases muscle tone; I can just leap out of bed to get my baby out of the bassinet. No, my spouse couldn’t stay with me. He had to watch our other child and he had to work. And no, we didn’t live where any family members could rush in to help, either.

Fortunately, I delivered in a hospital where I could have the baby in the room as much as I wanted (pretty much full time, but sent her back to the nursery as needed), breastfed on demand with supplementation if desired, and had a very good experience all around.

guest

The magnesium made me really clumsy. I kept dropping things, like bottles of pumped milk. Thankfully no one in my hospital expected me to care for infants in that condition. There’s a good chance I would have dropped one.

theoriginalguest

Wow, now you’ve stooped to making fun of a woman who was on seizure precautions and on magnesium. You’re not a real nurse. There’s no way! Magnesium makes you more than just clumsy. If you were a nurse you’d know this, you’d understand that this is serious business and you’re dealing with a woman potentially loosing her life and the baby’s. We monitor these women VERY closely, they feel like shit, and it only takes a second to fall asleep and drop the infant! We monitor these women very closely for magnesium toxicity, which obviously your country knows nothing about! Instead, you’re just on here to mock women who’ve had very serious life threatening experiences. You’re either an ignorant man or a very mean, not very empathetic woman. If you are a nurse, you shouldn’t be. Find another profession!

guest

I can’t tell which “guest” comment you are replying to, but if it’s mine about how *I* was clumsy on magnesium, I’m not mocking anyone at all. That was my experience. I was clumsy. I dropped things. I really might have dropped one of my babies if I had been forced to room in with them in that state.

And I’m not a nurse, so don’t worry there. I’m one of the guests who is a fan of Dr. T.

Nick Sanders

Easy way to check: hover your mouse over the name of the person being replied to, and a little pop-up window will show the beginning of the post which was replied to. You can even click the name to go straight to that post.

guest

Oh, thanks!

I’m not bothered by the response, but I didn’t want anyone to think my original comment was mocking anyone. It definitely wasn’t.

Nick Sanders

You, we can have more than one guest without a Disqus account here at a time.

Charybdis

Please explain to the peanut gallery why third world guidelines are being applied to a first world country>

Mac Sherbert

Maybe I have heard their rationale and disagree.

theoriginalguest

It’s like there’s a broken record on here! You guys only have one argument…..here, look at this research that isn’t even really valid research! Yeah, already looked at it before! Thanks but no thanks! We know what it says and we don’t buy it! And we really don’t care what WHO or Unicef has to say about breastfeeding or rooming-in! You’re not going to convince us by continuing to tell us to look at it or posting links to it! We know what it says already! We are not all the same and we don’t need to all do things the same way. No matter what WHO or Unicef has to say! You only have one argument and it doesn’t work! Glad you’re not a lawyer!

DelphiniumFalcon

Well. Since i have a meme or youtube video for everything. Anyone else feel like when someone comes in with crappy research and keep posting it over and over when you try to an answer out of them and they freak out it looks like this?http://m.youtube.com/watch?v=JUwYZUFzs7g

Obnurse

You are absolutely ridiculous. Can you tell me the rationale for rooming in? Do you even know the evidence behind the concept of rooming in? You do realize that there is Baby Friendly International and Baby Friendly USA. Baby Friendly USA had to be created because they knew the Baby Friendly International initiatives would be too much for Americans to handle. Mother’s have 1,500 guests visiting all day keeping her from resting. I think hospitals should ban visitors to maternity wards so mothers can rest. Or instead, 1 visitor at a time to watch the baby IN THE ROOM while mom rests.

The Computer Ate My Nym

So basically you’re saying that it’s the patient’s responsibility to do your work. If the baby smothers while they sleep, it’s their own fault for not having a “support person” with them at all times.

And why do you keep insisting on putting an apostrophe in “mother’s” when you mean the plural rather than the possessive?

Can you tell me the rationale for rooming in? Do you even know the evidence behind the concept of rooming in?

And since you brought it up, do you? What is the rationale behind rooming in? What outcomes are improved by rooming in and what is the evidence that those outcomes are improved? A lot of us quite enjoy reviewing data and would love to see what you’re basing your statements on.

Chi

Why should a woman who has been through something that is both physically and mentally exhausting, who may be on narcotics for pain, HAVE to be the one responsible when she is technically a patient of the hospital herself.

Hospitals have a duty of care to both babies AND their mothers and forcing a tired, possibly drugged mother, to be in sole charge of her newborn is borderline gross negligence.

Oh they have their own bassinet? What if they’ve had a c-section and lifting the child in and out is too painful? What if it’s just easier for them to lay the kid beside them because they’re too tired to realize the risks?

Why the hell should they carry this burden when hospitals should be providing the help they need while THEY ARE A PATIENT???

Would you expect a post-surgery patient to redress their own wounds? Or self-administer their own medications?

Why the hell do we have a different standard for new mothers as patients than we do all other patients in hospital?

Linden

“Why the hell do we have a different standard for new mothers as patients than we do all other patients in hospital?”
Sexism.

Chi

Touche. Mind you, it’s not just in the maternity wards. Women who request pain relief in hospital are often ignored, or told they’re exaggerating, or to calm down and don’t make a fuss or whatever.

DelphiniumFalcon

Ain’t that the truth.

I got sent home from the ER barely able to pee while passing a kidney stone with -no- pain killers and told it was a pulled back muscle and I was overreacting.

One lithotripsy and ureter stent later in the week when I was finally able to get in to a uriologist… I hope that ER doc felt like an ass.

BeatriceC

Meanwhile MrC was sent home with a morphine supply to help him cope with kidney stones.

DelphiniumFalcon

…lucky bastard.

Which I mean with no actual offense to MrC but damn that would have been nice.

BeatriceC

If it makes you feel better I said the exact same thing when I saw the prescription. Women get sent home with advil and told to stop being dramatic. A 60yo male gets sent home with 45-15mg morphine pills. Disparate treatment is a very real problem in the American medical system.

DelphiniumFalcon

It really is and it’s worse if you’re a woman with a mental illness diagnosis on top of it.

I’ll need to do some digging but I remember reading a story years back about a woman with bipolar disorder who ended up deaf in one ear because all her medical providers assumed she was making a scene and overreacting over nothing and didn’t even bother to look in her ears. Turns out she had a raging ear infection that couldn’t drain. Yeah she got monetary compensation but that doesn’t bring her hearing back or take away weeks of pain.

KeeperOfTheBooks

Not to mention an appropriate standard of care.

anh

why do women cease being your patient the second they deliver the placenta? Rooming in is a great option if you want it but this initiative forces it upon women. Can you not see how dangerous it is to deprive women of a choice? For a lot of us it’s next to impossible to sleep if the baby is in the room. every grunt makes us bolt awake. Why on earth aren’t you willing to concede the importance of true postpartum recovery? I cannot believe the way you completely disregard the needs of your patients.

MaineJen

Again with the “banning visitors” thing. I’m beginning to think you don’t want all those people in there so they won’t interfere with the breast-is-best indoctrination.

You know who kept me from sleeping in the hospital? The nurses. Yup. They woke me up every hour or so to take vitals, to take the baby to be weighed, have a hearing test, take a blood sample, etc.

It was annoying, but I understood the logic behind it. I don’t understand the logic behind mandatory rooming-in.

Charybdis

How is the new mother supposed to rest with a newborn in the room that she is supposed to take complete and total care of BY HERSELF after a major physical exertion and toll on her body? Sleep deprivation, medication, etc make it difficult to care for yourself, much less a helpless newborn.

What, pray tell, is the supposed rationale for rooming in?

guest

Why do American women think they will ever be able to rest after having a child? Haha. In my country, you take care of your baby after delivery until they are grown. Life is hard and not a luxury but that is life.

Who?

And here’s the suffering competition entry.

My bingo card is complete.

Nick Sanders

Because we like to pretend we are a first world country and women are more than slaves to their family.

BeatriceC

What country is that? As far as I know, there’s never been any culture anywhere in the world at any time in history that doesn’t recognize they physical effort required to birth a child and provide some sort of support in the first few days and weeks postpartum.

theoriginalguest

Bingo, you’re not even from the U.S. Ok, so why the hell are you so invested in what we do! Women here take care of their children until they are grown too. They are just lucky enough to have a nursery in many hospitals that they can send their infants to between feedings. I’m done arguing with guest, obnurse, and mrobnurse too! Can’t argue with stupid!

Sue

Could it be because American women are paying for hospital care? Could it be that they want some service from an alleged health care provider?

Actually, many traditional societies DO NOT expect new mothers to do anything other than mother – as in the 40-day “lying in” period. In many cultures, there are extended families and group child-care. Isolation is not the norm.

BeatriceC

I’m just a ridiculous, stupid woman. Why should I need to explain everything. After all, you menfolk know everything!

You’re a troll. I’m done responding because you’re not worth my time. I have more important things to do, like actually care for my kids, who are now awake.

Monkey Professor for a Head

What is the rationale behind not allowing women a choice in the matter?

BeatriceC

I banned all visitors, including my husband, for most of my hospital stays. My middle child was the one I felt the best after delivering, and was also the one I had the most visitors, per my request. Funny how I seemed to know what my body needed and what it needed was rest, so I took action to get that rest, which meant not allowing visitors. But never mind, I’m just a stupid woman, so obviously I can’t be trusted to make that decision.

theoriginalguest

Obnurse, The rationale for rooming in is absolute BS! I spent the first 7 days of my life in the nursery due to a crash c-section many many years ago, and I bonded with my mother just fine! I was attached to her hip as a child! And guess what, she didn’t even breastfeed, and we STILL bonded! Why? Because I had a good mother! She’s been my best friend since I was in my early 20’s and none of it has anything to do with rooming in or breastfeeding! You can breastfeed until the cows come home and have a horrible mother, and the bonding between mother and child will be impaired. Bonding has VERY little to do with rooming in or breastfeeding, and I find it hilarious that people like you still keep trying to pretend that if infants don’t room in or breastfeed that they won’t bond with their mothers. If this was the case, no one would EVER bond with their fathers because they didn’t breastfeed their kids. No mom would EVER bond with an infant that spent time in the NICU either. Your rationales are proven false time and time again! And you CANNOT compare other countries and their policies to the U.S. These women have NO choice in other countries. Why the hell do you think so many foreigners some how just end up in the U.S. to deliver their infants? They want to be here! And guess what, our foreign patients use our nursery! In America, women have choices! And women don’t want Baby Friendly USA here! They’re speaking out about it! I’ve been a nurse for 20 yrs, and I’ve seen women breastfeed successfully AND bond very well WHILE sending their infants to the nursery between feedings to get some rest. Guest, obnurse, and mrobnurse are probably all men who enjoy telling everyone what THEY should be doing. Worry about yourselves! And thank GOD I don’t work with any nurses like you!

theoriginalguest

Women aren’t stupid enough to swallow your kool-aid as rationale! They have brains to make their own choices. Read the whole Baby Friendly initiative! The research is all done is other countries, and the research is all old and isn’t even valid anymore, and there’s not even enough research to support it. Also, you can’t draw the cause and effect conclusions that lactivists are drawing from this research! For women who want to room in and breastfeed, this has always and will continue to be supported! Stop trying to make everyone do what you think they should be doing.

BeatriceC

“You can breastfeed until the cows come home and have a horrible mother, and the bonding between mother and child will be impaired”

I was breastfed. As an adult my choice was to move 3000 miles away and cut off all contact with my parents. They are not nice people.

guest

If you “rested” during the day in my hospital, you missed meals. While “resting,” nurses and doctors will wake you ever 30 to 60 minutes to ask whether you’ve watched the Shaken Baby video yet, or ask you to fill out another form, or check your temperature, or whatever. There is also more noise during the daytime. You are quite stupid. Have you ever even been on a maternity ward?

Monkey Professor for a Head

When I gave birth to my son, the maternity ward had a mandatory two hour rest period during the day where visitors were not allowed. Unfortunately the day after my son was born, someone decided that was the perfect time to test all the alarms on the ward.

Even without that, I doubt I would have gotten much rest. As someone who has worked plenty of night shifts, I’ve never found it easy to get adequate good quality sleep during the daytime, even given optimal conditions. Circadian rhythm and all that. And 8 hours of sleep taken in 1 hour increments is certainly not equivalent to 8 hours of sleep in one stretch. A nurse should be intimitely acquainted with the exhaustion of night shifts.

moto_librarian

I had serious complications after my first delivery (cervical laceration, pph nearly requiring transfusion, 2nd degree tear). I required extra monitoring, which meant I was getting woken up frequently. I don’t begrudge the nurses that one bit – I know they needed to make sure that I was okay – but it also meant that I wasn’t getting much rest. I had almost no visitors, but instead of resting, I was spending a lot of time trying to pump for our son, who was in the NICU for TTN despite having been born after an all “natural” vaginal delivery at 38 + 3. I was also very weak and in a lot of pain. If he had been well, there was no way I would have been well enough to care for him. I was in a wheelchair the first 24 hours after birth because I was so weak from blood loss, and I was on heavy pain killers.

LaMont

Well it’s not a purely cynical cash-grab, it can help crystallize how legal responsibility works for these instances. Obviously, “responsibility” only has two real consequences (fines or prison), but it’s bigger-picture than wanting money, and pretty legitimate for that reason!

KeeperOfTheBooks

Friends of ours had their baby readmitted to the hospital over BFHI crap. It was clearly 100% preventable, and due entirely to the nurse refusing to allow them to feed their baby the formula that the PEDIATRICIAN told them to feed the baby in order to prevent jaundice. When I told DH about that, he exploded and vowed that should that ever happen to a kid of ours, they’d never see a dime of our money for the readmission, and if they tried to collect, that’s when he’d find a thoroughly nasty-minded attorney to deal with them. And we aren’t exactly the sue-happy types either.

Who?

It really raises the question of who is responsible for the baby while it is in hospital after it’s born.

Is the baby a patient, in which case the nurse/doctors/hospital are responsible for care related issues. Mind you I doubt the nursing notes reflect the nurse refusing to supply the prescribed formula.

Lawyer’s picnic there.

KeeperOfTheBooks

Quite.
To the pediatrician’s credit, I understand he called the unit to raise fifty shades of hell with the nurse once he found out what happened, but the whole situation was inexcusable, even by BFHI standards. (Hint: if a pediatrician says to feed the baby formula to clear bilirubin from her system, it damn well IS medically-necessary!)

Kelly

When it can damage your child and there is a way to easily prevent it, I think you have the right to sue. This is not about the decor or the tone of a nurse, it is about the health of a baby. This is awful what they are doing to people.

Eater of Worlds

I had kernicterus due to really bad jaundice. I was hospitalized for nearly a month to get it under control. I’m deaf now. While I don’t think deafness is the end of the world and it’s one of the easier things to deal with, who the hell would knowingly do this to their kid when it can be easily prevented by food?

I don’t know any Deaf parents, who often prefer Deaf kids, who would do this to their kids. But people who fall for the woo are apparently fine with it.

I knew when they passed the law it was going to end up resulting in situations where providers would feel their hands were tied inducing labor before viability for medical reasons. I hope it’s challenged in court.

Mad Hatter

So is nipple confusion really not something to worry about? I’d have supplemented with my first, if I hadn’t believed that colostrum was all that was needed until my milk came in. My milk didn’t start coming in until 4 days after he was born and lost about 10% of his body weight. I am pregnant with #2 and don’t want to have the same thing happen.

Elisabetta Aurora

I supplemented for the first 8 weeks. My pediatrician told me his wife had done the same with both of their children.

I never had a problem with my baby wanting to nurse. She nursed like crazy. At 7 months when I wanted to quit, I had a very hard time getting her to switch to bottles. I wished that I had kept up with a bottle a day after the supplementation was no longer necessary so that she would transition to bottles easier.

Sue

Having heard about a colleague who had to delay a return to work due to her baby refusing a bottle (to the extent of almost becoming dehyrated), I used a bottle with expressed milk from the beginning. That also allowed for other people to feed the child.

Green Fish

Nipple confusion can happen. I’m having it right now with #2.

But still I wouldn’t have done anything different. Supplementing with formula was right. Pumping and then bottlefeeding that milk when he still was to weak to breastfeed was right.
Letting him go even more hungry, letting him lose even more weight would have been wrong.

We’re now currently slowly working our way back to drinking directly from the breast. So far he accepts it with nipple shields but doesn’t drink enough. So I pump and bottle feed.

And why do I want to breastfeed?
For a totally selfish reason: I enjoyed breastfeeding a lot with #1. And I would like to have that again.
But I won’t let my baby pay the price for this wish of mine.
He gets as much milk as he wants from the bottle.
We snuggle and and see if he wants to accept the breast now and then. And we’re making slow “progress”. But no stress and no hunger for my little boy.

So yeah, you CAN worry about nipple confusion. But I don’t think worrying about it will yield good results.

Eater of Worlds

That sounds more like nipple preference than confusion. I don’t know why they call it confusion to begin with.

Kelly

Mine had that problem and she just could not handle the amount of effort it took to get the milk out. I tried a very slow nipple when she was a month old and she kept falling asleep and waking up ten minutes later just like she did when I was trying to nurse her. My other two did not have any problems with nursing or taking the slow nipples.

Mac Sherbert

My milk comes in late too. I always just supplement at the breast with those little syringes until my milk comes in. Then once BF is “established” I’ll give an occasional bottle.

Obnurse

Every baby and every situation is different. Nipple confusion is real and it is sad how unsupported people are of breastfeeding mothers trying to be successful. Follow EVIDENCE BASED practices, not practices you read about on blogs. Don’t let the fear mongering that this blog and these comments stir up cause you to doubt yourself and be discouraged before you even try. Your Healthcare providers are NOT idiots like many of these people seem to think. The FDA, WHO, Unicef, AAP have evidence based information. Colostrum is all that your baby needs those first few days. They do not need 4 ounces of formula/breastmilk/kool-aid in their tummy that is smaller than a shooter marble. They need to nurse every 2 hours and all will be good. If there are issues, ALWAYS seek PROFESSIONAL help.

Sue

This fly-in person lands on an OB’s blog, which dissects the research evidence in detail, and whose commenters include other OBs, CNMs, NICU nurses and many other clinical professionals, and advises us not to get information from “blogs”.

Sigh.

Mrobnurse

You’re right. This is just a biased forum full of closed mided, sue happy, think they know everything people. Please folks, opt for a home delivery.

MI Dawn

Dear Mrobnurse: you’re full of it. As a CNM, nurse, AND woman who nursed her own children, until you have documentation that supports your side, stfu.

Home delivery: with higher risks of dying in the US than hospital births.

EBF: force a woman to breastfeed because SHE’s not important, only the baby. Let the baby starve if mom doesn’t create enough milk because BREAST IS BEST.

My EBF kids nursed every 3-4 hours on demand. If I’d tried to nurse them every 2 hours, they would have vomited and had reflux, since I had (like Beatrice C) enough milk for a football team. I gave them bottles once I went back to work. They still nursed when we were together, took bottles when we weren’t.

When you have more to say than your small-minded demands, come back and visit. Maybe you’ll learn something.

Credentials:
BNS, University of Michigan
RNC in Obstetrics back in the days I was practicing.
CNM: Frontier School of Midwifery, CNEP program
MSN: SUNY Stony Brook

What are your credentials?

guest

Is part of your practice as a licensed nurse to practice by current evidence based recommendations? Please get yourself up to date so that you are not practicing by old standards.

Please stop using guidelines and recommendations for third world countries as a valid comparison for what *should* be done in first world countries.

Things like breastfeeding in third world country or somewhere a clean, safe water supply is not easily available, is NOT the same thing as damn near requiring a woman in a first world country or a place where she has ready access to clean, safe water to breastfeed exclusively. Because it is *safer* in place with no clean, safe water does not make it “better” where there is clean, safe water.

Skin-to-skin is a recommendation for a place without a NICU/nursery to help keep the baby’s temperature regulated. This does not translate to a first world country where there are other alternatives. People glom onto those guidelines/recommendations as Gospel and absolutely refuse to view them as just that: RECOMMENDATIONS. “So it is written, so shall it be done” and all that garbage.

DelphiniumFalcon

On the clean water thing, Americans (like myself) have no idea how lucky we are that we can turn on the tap and get clean water. Not that you’d know from the flourode conspiracy nuts but that’s neither here nor there for this.

When my husband was working at a hotel for a ski resort that attracts a lot of foreign tourists he was puzzled when one of said foreign torusits asked where to get water for tea. My husband without thinking pointed to the kitchen to ask them and said they could ask to use the tap if someone wasn’t there if they need it later too.

And then the tourist looked at him dumbfounded and said “Is that safe?” My husband said “Yeah, if you really wanted to you could drink water from the bathroom tap and it’d be safe to drink.” And this tourist was blown away that you could get clean, drinkable water from just about any water fixure in the hotel. And my husband realized he’d never even given it a passing thought before that he could turn on any facet in our house and get clean water.

theoriginalguest

Yes, we ALL know that this link is the Bible for maternal/infant care! Thank God you keep posting it or I wouldn’t know how to do my job correctly! Wait, I take my previous comment back! You’ve finally convinced me after posting the same damn thing for the 1000th time! Please, don’t listen to your OB or your real nurses. Listen to guest, obnurse, and mrobnurse on a blog where they only have one thing that they keep citing! Thank God most people in America aren’t this stupid! Hence the push back against BFHI, and the reason that everyone on here is arguing against you! I second the stfu! Coming from an RN with a BSN and 20 yrs of nursing experience. You still can’t answer what your credentials are because you don’t have any! OH and by the way, our infants are COLD and have low blood sugars after doing skin to skin, over and over again. Maybe in a country where you have no warmers and it’s 100 degrees year round, skin to skin works. But, we’ve been proving that radiant infant warmers keep our infants warm and blood sugars up for about two years now! Imagine that! An infant warmer actually keeps an infant warm! So yeah, keep posting that same post! Tell me about the real life nursing experience you have. A real nurse could actually argue from her experience and wouldn’t just keep posting the same thing over and over again! I agree with MI Dawn, stfu!

theoriginalguest

Yes, opt for a home delivery woman! Great advice from an OB nurse! How about listen to your OB and your REAL nurses instead of some jackwagon on a blog named Mrobnurse!

Sue

“tummy that is smaller than a shooter marble”

OB nurse, have you never seen a newborn’s gastric bubble on XRay? (Sorry – “tummy” bubble).

No marble. And very distensible.

Mrobnurse

Of course the stomach can distend. Of course you could shove 2 ounces in there and then the baby is spitting up and then you have to change formulas because oh no the baby probably has reflux! Ha!!!

T.

I am curious, do you know where the whole “as big as a marble” stuff comes from?

I know, btw. It was discussed in the comments some time back.

Do you? Or perhaps you just heard it somewhere and latched on it because it confirmed your bias?

Monkey Professor for a Head

The first night after bringing my son home, I hand expressed and syringe fed (so not exactly shoving it down his throat) because nursing was too painful. I looked at those descriptions of how much a baby of that age needs, and gave him that much, but he was clearly still hungry. He wasn’t satisfied until we gave him twice as much as he apparently needed. He didn’t spit up, and he was hungry again 2 hours later.

Perhaps different babies have different needs? Perhaps for some babies a small amount of colostrum is not sufficient?

MaineJen

Your casual dismissal of real concerns in favor of the Party Line tells me everything. If you are really an OB nurse I’m scared.

Sue

Huh?

Take a look at the film. The stomach is full of air, not milk. It’s much larger than a marble.

QID.

Suzanne

Yes, because a 6 lb newborn’s stomach is exactly the same size as a 10 lb newborn. And a 19 inch long baby needs exactly the same amount of food as my 23 incher (or my 24 inch 11.5 pound nephew).

Why on earthy would anyone think that? If the baby is showing signs of hunger and mom’s milk isn’t in, why on earth wouldn’t you feed the baby?

Megan

“Your Healthcare providers are NOT idiots like many of these people seem to think.”

You do realize that many of us ARE healthcare providers?

moto_librarian

It’s unfortunate that Obnurse demonstrably IS an idiot.

Valerie

Why don’t you go ahead and try to find the source for your statement that a newborn has a stomach size “smaller than a shooter marble.” I did. It’s based on an ignorant misinterpretation of research from 1920, measuring how much colostrum mothers produced. The researchers used the confusing term “physiologic capacity” to mean what the infants were able to get out of their mothers (by weight), not how big their stomachs are. We have several modern estimates (and anatomical estimates actually cited in that publication) that are on the order of 10x times bigger than that.

Nick Sanders

By allcaps “PROFESSIONAL help”, do you mean a pediatrician or neonatologist who will dutifully examine mother and baby, assess if there is a genuine problem, and possibly recommend supplementing with formula, based on what is best for the mother and infant both, or do you mean a lactation consultant, who will give the mom some cookies and herbs, say there might be a tongue tie with barely a peek in the mouth, and then give the mom an earful about “trying harder” and how any failure is her fault and dooms her baby to a life of mediocrity?

Suzi Screendoor

A question that has been on my mind lately is why the problem of inadequate supply isn’t taken more seriously. How many doctors/midwives are actually screening pregnant women for insufficient glandular tissue? Because even if this only affects 1% of women, that’s still a lot of babies who are going to go hungry while their mothers go undiagnosed

The Bofa on the Sofa

I still like the comment from Mel, who knows an awful lot about lactation. Granted, in dairy cows, but hey, that is where the whole world is lactation.

According to Mel, the first time mother lactation failure rate in dairy cows – you know, the animals BRED for their ability to make milk, is more than 10%. This is what they have been bred to do, and they still fail significantly.

Why should we expect humans to be better than that?

Of course, the problem with being a dairy cow and having lactation failure as a first time mother is that you don’t get to hang around to see how you do with the second birth.

Valerie

I’ve read stories of women, I think on here or the Fearless Formula Feeder, who had multiple known indicators that they would not produce enough milk but nobody told them until after the fact. One reason may be that there is a lot of old psych research that supposedly shows that a woman’s attitude determines her breastfeeding success- so there is still this idea that it’s better to just provide encouragement and affirmation because maybe it will help. If you tell her she’s at a higher risk of problems, then she will be more likely to have them.

I think the BFHI reasoning is something like this: Almost all mothers will be able to exclusively breastfeed if they follow all the advice of lactation consultants. Breastfeeding is often painful and difficult at first, and at that time women are at a high risk of quitting. We don’t want to tempt them into trying formula or let them give up, so we’re going to make formula feeding in a BF hospital very difficult, and we aren’t going to give them any reason to think that exclusively breastfeeding won’t work for them. It’s worth it if some (very few, really) babies get sick because they are malnourished if we get more mothers to establish breastfeeding.

Mac Sherbert

Since when is telling lies the right thing to do. It probably just makes these mothers think they are crazy because in their gut they know something is not right, but everyone is smiling like it’s all good. That’s got to be maddening.

Valerie

They don’t think they are lying. The ideology is pervasive, and there is a lot of misinformation.

I’ve posted about this before, but the one that makes me angry is the “a newborn’s stomach is the size of a cherry (or other tiny object).” It’s untrue and based on a misunderstanding of research from 1920. It’s used to tell mothers that their baby can’t be that hungry- he’s happy with the tiny amount of colostrum you made because his stomach is so tiny. And then some of those babies are actually in peril. It makes me feel sick to think about it.

Sue

Not to mention the fact that the stomach is a very distensible organ.

Here is an XRay of a newborn abdomen, showing how large the stomach is (arrowed):

nomofear

Gaslighting

Megan

I know that I have yet to get a diagnosis, even though I’ve now had two pregnancies where I’ve made at most 12 oz a day. I never had breast changes with my first pregnancy, had very little with the second. Milk came in much faster with the second and I had a baby who would latch and despite that, still didn’t make enough milk. I think the first time no one wanted to give me the diagnosis because the circumstances surrounding my first delivery were bad (PPH, CSection, Prolonged induction). Not sure what the reasoning is this time. I say to my doc “I think I have IGT.” and she says “Maybe.”

OBnurse

Because Americans want babies on their schedule versus following babies feeding cues. Babies need to nurse every 2 hours. As a society, that just doesn’t work for us. So we shove pacifiers in to keep babies content. They lose weight, our milk supply drops and bam—mom’s are weaning at 2 weeks old and don’t even know it because they ARE NOT INFORMED ON THE RISKS OF THESE BEHAVIORS AND HOW TO RECOGNIZE FEEDING CUES.

Sue

The fly-in who just told us that starving women have fat babies and that every baby is different is now telling us that “babies need to nurse every two hours”?

SOME COMMENTERS SHOW NO INSIGHT. AND ARE TOO SHOUTY.

Chi

If I didn’t know any better, I’d think that this is Brooke parachuting in under a new name.

This seriously appears to be her level of stupid and ignorance.

Sue

You’re right – I didn’t think of that.

BeatriceC

There’s a distinct linguistic difference between Brooke and obnurse. It’s far too consistent to be the same person attempting to obscure themselves.

ETA: At least in my opinion, which is certainly not expert. I’m a mathematician, not a linguist.

Chi

Maybe it’s one of her ‘friends’.

Either way. I’m going to say to you what I said to the other parachuters:

Troll corner is over there. I’m sure you and Brooke can spend plenty of time talking about mean, fearmongering Dr Amy.

Meanwhile, leave the science and its implications to the grownups.

demodocus

Mine slept (at least) 4 hours straight every night of his life. Startled the L&D nurse who came in to check on us, but if the kid’s sleeping, I’m not waking him (and neither did she).

MaineJen

“Babies need to nurse every 2 hours.”

“Every baby and every situation is different.”

Which is it? At least keep your story straight.

I had one baby who fed every 3-4 hours for 45 minutes at a time. The other baby ate every 2 hours for 5 minutes at a time. Same mom, same boobs, different kids. I didn’t use a pacifier for either of them. Somehow, we all survived, despite not getting a single scrap of advice from someone like you. Thank gods.

Megan

Ok, I just deleted an entire response to you that wasn’t for formpolite company or my professional reputation. Instead I will say this: Hou know absolutely nothing about my experiences breastfeeding or what I did/did not do. You know nothing of my medical history. In short, you know nothing. You go on pretending women who truly don’t make enough milk exist. I’ll still be here.

Madtowngirl

I’m one of those women! Finally got a PCOS diagnosis last month, 9 months after my baby was born. My breasts never changed size, and I had known high levels of prolactin. But no one dared utter a word to me about having potential issues with breastfeeding.

yentavegan

I have met women who’s breast never swelled or changed during pregnancy who have tubular breasts (all associated with IGT) who nonethe less produced adequate milk. I have seen mothers with every indication that they would not have a milk supply issue, indeed have milk supply issues. The number one red flag indicator is the failure to fill up/get engorged during the early week. If mother never gets engorged and has a baby who fails to regain birthweight by day 14….this is insufficient milk supply and none of the drugs/power pumping etc…will help unless baby is also supplemented. Baby needs calories more than mother needs to breastfeed.

Valerie

I think the point is, though, that a mother with these indicators should be told that she (or her baby, rather) is at risk so she can make an informed choice.

Obnurse

There are starving women in Ethiopia with minimal glandular tissue that feed fat little babies strictly from their breast because that’s all that they have. There is not way to TRULY know what a mother’s milk supply will be and discouraging any women without scientific proof on what will determine milk supply issues is a terrible idea.

Sue

Are you sure those “fat little babies” being fed by starving women aren’t just swollen from protein malnutrition?

Granted, some of it depends on sanitation and lack of vaccine, but I wouldn’t doubt that lack of infant nutrition is among the cause.
Of course, lack of sanitation makes formula unsafe as well, so if you don’t have enough milk you are left we the Old Option: letting your baby starve to death.

guest

The human race is more intelligent than that. It is called wet nursing. During times of natural disasters you will find many women being wet nurses to keep babies alive. Orphanages in Romania utilize wet nursing. It’s a beautiful thing.

Monkey Professor for a Head

It’s a thing which is not practical for many women. But I don’t think you care about that.

Starving communities have WET NURSES? Now we are really getting desperate to push an untenable arguement, aren’t we, “guest”?

MaineJen

I call BS. Breastmilk composition varies widely from person to person. Stop spouting the party line and actually think about this. JFC.

MI Dawn

Exactly. If a mom is very malnourished, her breastmilk will not be the same as a well-nourished woman. Studies HAVE shown that. Mrbonurse is spouting nonsense.

Sue

Yep – not to mention severe iron deficiency.

This alleged OB nurse has no idea.

OB nurse: what do you think breast milk is made from? Constituents in the mother’s blood, right? If the mother has severe protein malnutrition and low serum protein, as well as iron and other nutrients, where will the breast milk constituents come from?

Why do we advise lactating mothers to eat and drink more?

Certainly breast milk is better for babies in impoverished societies than contaminated water in formula mix – but that doesn’t mean all breast milk is the same.

Is there NO requirement to be scientifically educated to be an OB nurse?

guest

To maintain her nutrition. The body will deplete the mother to keep the next generation going before it will allow the mother to absorb nutrients.

So why is it repeatedly tested when women want to provide breastmilk for their very premature babies?

And if this is so, and mum is already malnourished, how does making this supermilk not further deplete her, risking the baby and any other children being left motherless? How is breastfeeding a better option than being orphaned?

anh

Do you have any idea what the perinatal mortality rate is in sub-Saharan Africa? or Ethiopia specifically? You couldn’t possibly, or else you would never had said something so callous and ridiculous.
You apparently aren’t aware that countries with the highest EBF rates have the highest rates of infant death?

Nick Sanders

If the mother is starving, where is she generating the calories to produce milk for a “fat little baby”? Conservation of energy seems to rule that out, baring her body cannibalizing it’s tissues to ensure milk supply, which seems like the kind of thing that evolution would have prevented. Granted, I’m neither a doctor nor a zoologist, but I was under the impression that mammals stop producing milk when severely underfed.

BeatriceC

I think it was one of the February issues of “Cell” that published a study of sialyated milk oligosaccharides that are secreted in some women’s breast milk and not others that contribute to the reduction of risk for infant growth stunting. It might be relevant here, though MrC seems to think they’re using a bit of double speak in some places to get around not admitting to something they don’t want to admit to. I’m still working on understanding the darned thing! He has a subscription, but here’s a link to the part that “Cell” doesn’t have behind a paywall.

My hospital wasn’t officially “baby friendly,” but it was in NYC where formula was supposed to be locked up and only distributed with a lecture. As it happened, my twins were born premature and whisked off to the NICU after being briefly held in front of my face so I could see them. I pumped for them and sent what I had down to the NICU, but the first 24 hours I could not move (post c-section) between floors and had no idea how much they were eating. I told a nurse that they should be given formula if there wasn’t enough breast milk. I’m not sure she passed the message on. It was a confusing time.

When I did get down to the NICU, I discovered that *all* NICU babies automatically got six-packs of ready-to-feed formula in their supply drawers. The nurses would use breast milk if it was provided, but they did not fuck around down there: If a premature infant was due to be fed, it would be fed one way or the other.

I still have no idea if my babies were given any formula that first day, because no one thought it was important enough to mention (and I didn’t care, so I didn’t ask). Those RTF nursettes followed them up to the transition nursery, though, and I was encouraged to take them home with me when they were discharged. No one ever lectured me.

moto_librarian

Our eldest son was admitted to the NICU for TTN (he was early term, 38 + 3). It happened just after I was out of surgery for my cervical laceration. I didn’t see him until mid-morning the next day, and he was given formula. I had no problem with this whatsoever, particularly because he had to demonstrate that he could eat without problems before he could be discharged. Our attempts to breastfeed in the NICU were difficult – I was exhausted, weak, and in pain, and the lactation consultant was a royal bitch who grabbed my breasts without asking permission and criticized my attempts to latch my son. The NICU nurse was far more helpful, giving me a nipple shield when I came to give him a late night feed. She also encouraged me to supplement him.

guest

I had zero success breastfeeding in the NICU. I gave up trying, and the hospital staff never said anything. After they came home (at eight and nine days old) I worked on getting them onto the breast, and it took some time, but we did it.

The LC I saw while in the hospital was not grabby at all, and she was the one who told me that my daughter was probably just too small to work a breast. No judgement for using bottles. I was lucky in many ways.

Fuzzyfuzz

It’s honestly not even “Breastfeeding Friendly” by disallowing supplementation–which has been shown to help breastfeeding rates, as Dr. Amy states. If it’s ‘anything’ friendly, it’s “Lactivist Friendly.”

Guest

Yeah, her research—is wrong. Always, ALWAYS cross check research presented to you by ONE person

Chi

Citation on why Dr Amy is wrong.

Sue

Many of us here have the skills to read and interpret the research ourselves.

BeatriceC

Some of us have to occasionally ask the resident scientist for a little help. Actually, we make a good team. I sometimes have to ask him to explain the more technical points regarding the biology and chemistry, and he sometimes has to ask me to explain the statistical analysis. We both have a basic idea of what’s going on with the other’s speciality, but it is nice so have such a convenient resource to ask when picky questions arise.

Sue

Exactly – readers here have access to a wide range of skills. The opposite to the indoctrination of the radical lactivist movement, where they can only post links.

Charybdis

But you want us to accept research presented by you: ONE PERSON. Granted, you didn’t actually DO any of the research, but you keep dropping the same link over and over and over and want us to accept it.

Valerie

Great post! Thanks, Dr. Amy, for highlighting the biological reality and cruelty. It seems like so much of breastfeeding promotion (and research) seems to start with the premise that it works optimally the vast majority of the time if the mom just follows all the advice. They completely ignore the fact that there is a gap of days between birth and when most mothers make enough milk- days during which many exclusively breastfed babies will be hungry, even starving. This may be “physiological,” but it is not optimal.

AirPlant

It isn’t my business, but a college acquaintance of mine just had a baby. Textbook pregnancy and delivery and everything, until an hour after birth they realize something is wrong. The baby has a heart condition and needs to be helicopter lifted half way across the state for immediate surgery.
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Obviously this was pretty stressful and the parents didn’t do the usual facebook birth announcement, so I found out what happened when they posted a gofundme to help with the crazy medical bills that they now have. I read the page and I know it is a stupid thing to fixate on, but in the middle of the list of things that happened to this poor baby and family is “Mom has had her tear filled moments, but she still had it in her to make sure that baby has had nothing but her breastmilk throughout this whole ordeal. The doctor said that most cardiac kids should be on formula but nothing but the best is good enough for our girl!”
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It is so not my business, but that sentence just chilled me to the core. I am sure it is fine and the baby is getting the nutrition that she needs and there are enough sane doctors in the mix that the baby will be just fine, but the message is so very very frightening and it scares me so much that even when you have an extremely sick and delicate baby somehow the priority is still breastmilk. That the genetic luck that allowed this first time mom to pump enough to sustain her baby is somehow a mark of superior love. That going against your doctor’s advice is somehow perfectly OK when it is to give breastmilk. I wish that baby all the best, but I hate this culture that is faster to celebrate an at risk child being exclusively breastfed than the medical miracle of that being even living past her first hours of life.

Roadstergal

I love the sneering implication that the *$#^% _specialist_ doesn’t know what’s ‘best’ for their vulnerable baby.

AirPlant

I am creepy af so I googled why babies with heart conditions end up on formula. Not a doctor obvs, but apparently even after surgery most babies with heart conditions are not great at getting oxygen into their blood and they tire easily. They are apparently generally fed special formula that is extra super duper calorie rich because it improves outcomes. Breastfeeding from the tap is supposed to be actually dangerous because it uses valuable energy that they need just to stay alive.
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To privilege your “good breastfeeding mommy” card over the actual health of your baby just feels like a special level of madness.

Roadstergal

I can understand feeling helpless and wanting to do _something_ for your baby in such a circumstance, rather than stand by helplessly. But listen to your doctors and do things that are actually helpful. Going against medical advice for your desperately ill baby… I mean, it feels a bit like offering sex to a friend’s husband in the hospital. Yes, you’re trying to be helpful, but there’s got to be more appropriate ways…

StephanieA

This is why we don’t recommend attempting to nurse for a long time. People often don’t realize how many precious calories babies expend by attempting to latch. If they can’t latch, they become frustrated, which then expends more calories. If we have a baby with a latching problem we try for maybe 10 minutes, then bottle feed or syringe feed (syringe feeding is pushed at my BFH of course, despite the fact that nipple confusion is so rare).

Wendy Dwyer

This time I actually had the in house ped tell me that nipple confusion wasn’t really so much a thing as nipple preference. He said breastfeeding was equivalent to eating cereal with chopsticks vs. a spoon. Both get the job done, but one would obviously prefer the spoon!

guest

Preemies sometimes get the enriched calorie formula, too. I was told that if I ever had low supply, that’s what I should give my daughter. When you’re tiny or sick, sometimes you need more bang for your buck, so to speak. Weak sucking or low energy leads to babies who don’t get enough calories.

BeatriceC

When my youngest was transitioned to the NG tube my milk was tested to make sure it had enough of everything he needed. If that hadn’t been the case, he’d have been given a specialty preemie formula. They continued to test it intermittently to make sure he was getting what he needed from me. Even for a 24 weeker he had a difficult time, and spent 6 months in the NICU, which is longer than average. Every obstacle seemed to be met with “test the milk”. And that was totally fine by me. I prefer my babies alive, thank you very much.

Dr Kitty

Cardiac babies often expend as much energy BF as they gain in calories from it.
If parents insist on breast milk, the milk is usually mixed with a high calorie fortifier and the babies are either fed the mixture by NG tube or bottle.

BF is NOT best for these babies, certainly not unfortified breast milk from the breast.

Hopefully the parents will realise this before the baby stops thriving.

AirPlant

Thank you, I always appreciate when I hear from a real expert. They didn’t specify that the baby was being fed from the breast, so the baby is probably getting the fortified stuff.

Madtowngirl

Honestly, I would have fixated on that, too. This child has a condition that could kill her, but they’re focused on making sure she gets breasmilk. This is a prime example of why the “breast is best” propaganda needs to stop. If formula hadn’t been so demonized, perhaps they’d be more open to it.

An Actual Attorney

Maybe, just maybe they mean fortified breast milk, but didn’t go into details on line?

AirPlant

I think that had to be it for sure when the baby was still in intensive care. I honestly don’t know any details, and I feel like my concern is nosy and misplaced and voyeuristic because it is not my baby it is not polite to have strong opinions about the babies of mere acquaintances, but the way that they emphasized that the baby was getting breast milk struck me strangely and it seemed indicative of our current breast at all cost culture.

Kelly

I agree but I bet she feels that this is the only thing she can do to help and that will be fueling their feelings as well.

Lorena

I also have a baby who was born with a serious heart defect (HLHS), so I’m compelled to share some insight from the inside. In my case, I was diagnosed at 20 weeks pregnant, so had a lot of time to prepare. I joined a Facebook page for parents of HLHSers. The newly diagnosed- including me, this time last year- most often want to know- can I breastfeed? Will I be able to hold my baby as soon as he is born? Will we have trouble bonding since he will be taken straight to the NICU? This is largely a coping mechanism, because you can’t always be thinking about the fact that your baby may die. It’s nice to think that you can still control something, hopefully influence your baby in a positive manner. When your baby’s in the NICU, hooked up to a ventilator and you can’t even hold him, pumping breast milk is basically all you can do to feel as though you are doing something for your baby. Also, yes, it’s an indication of how pervasive and obsessive the ideals of natural parenting are.
Of course, I don’t think she should be blatantly going against her doctor’s instructions. But interestingly enough, my son’s surgeon insisted on breast milk if at all possible. It was fortified with formula in most cases for reasons other posters have already mentioned (mine was not because my baby did unusually well and gained enough without). The idea was that reducing colds and possibly other infections- although not very important in the general baby population- was very important to these babies. Between operations 1 (during the first week of life) and 2 (at 4- 6 months old), a cold could easily land an HLHS baby in the hospital (due largely to their chronic low oxygen saturations). The hospitalisation could expose the baby to further infectious diseases, and/or delay the second operation, and that could- worst case- be a matter of life or death.
Anyhow, just wanted to give some insight. Your friend (or acquaintance) is likely overwhelmed, terrified and struggling to feel in control. I was also obsessed with things like avoiding a c-section (had one anyways for breech presentation, not because of the heart condition), and breastfeeding, and now I’m just so thankful for modern medicine and the surgeon for saving my son’s life. The details don’t matter. My perspective has shifted drastically and I bet hers will too.

indigosky

Do you know what happens to babies in orphanages who cry and cry because they are hungry and people ignore them? They stop crying because they give up. But not after they stress the hell out of their little bodies. Yet I have heard moms who have been so pressured to breastfeed that their babies ended up doing the same thing – shutting up because they gave up ever being fully fed. And yet the same Breastapo is against Ferberizing because it stresses the baby out. WTF?

Tokyobelle

But didn’t you know that the magical breast milk (once it comes in) will heal any anxiety and trauma incurred. But only if the mom had a healing home water birth, of course.

indigosky

With dolphin midwives.

guest

This thought is what got me to start coming out of my woo haze. I tried breastfeeding but my son was getting more and more agitated as the days went by. I finally realized what was wrong and fed him a bottle and he fell asleep for the first time in 24 hours. I called my doula to discuss what to do now and her advice that we just needed to push through this to establish breastfeeding seemed nuts to me. It felt like torturing him and I couldn’t do it. So we bottle fed happily…after my one breakdown in tears that I was a horrible mother for not trying harder to breastfeed. Even in my crazy hormone haze, I realized that was not a sane way to think.

Megan

I’m so glad my lactational haze is over. It is real. I think part of the reason that it’s so hard to give up breastfeeding is hormonal. The pressure to breastfeed only multiplies that.

Hiro

I wish someone had mentioned it to me! I was blindsided by mine. I didn’t even realise what was happening to me, I put two and two together about a week after I came home. When my milk came in I was °loopy° for at least four weeks. The first two of those, I was sheet-white. Paler than I’ve ever been in my life. My husband at one point made me sit down because he was sure I was on the verge of fainting/vomiting/imploding, and it was only then I realised I was trembling 🙁 My milk coming in and breastfeeding were linked up (for me) with horrible intrusive thoughts and obsessive thoughts, too. And still, despite going into the whole business a skeptic, science-based-everything, AND combo feeding from the get-go, I found myself on the bathroom floor at 4 am manually pumping one day when I could’ve been sleeping because I was terrified of tanking my supply…despite all the things in my brain telling me that I gave 0 fucks about my supply in the first place. I have felt that out-of-control only once before in my life and at that point in time I sort of knew what was going on, °this° totally came at me from nowhere!

KeeperOfTheBooks

Upvoted for solidarity.

Tokyobelle

What I truly think is hilarious* about BFHI, is their continued insistence that more women don’t breastfeed because they don’t know how awesome it is.

Newsflash, lactivists: I teach high school. When your male students (teenage boys, mind you) if you breastfeed because that’s what’s best for the baby, then you can rest assured that your message is pretty fucking well publicized. It’s time to focus on the myriad of other issues inhibiting ebf like maternity leave, postnatal care, etc.

*Here, hilarious means I laugh as opposed to cry because people just don’t get it.

StephanieA

My mother truly enjoyed breastfeeding. I did not and stopped around 6 weeks and did not miss it one bit. I can understand enjoying it if it’s your first baby, or if you have a baby that feeds efficiently and doesn’t cluster feed and you have adequate supply. But many women don’t have the perfect breastfeeding scenario (my mother also didn’t work, which is a huge factor in choosing to continue breastfeeding).

Fleur

Yes, that’s what really gets on my nerves: all the whining that women in the developed world don’t breastfeed for very long because formula has better PR. Nope, formula has shit PR. I was only able to withstand all the “it will kill your baby” crap because I was exclusively formula fed myself and know that I didn’t suffer major organ failure or grow a second head as a result.

The reasons a lot of women don’t manage to breastfeed for very long are (a) it’s bloody hard, and (b) we can’t afford to take more than a few months maternity leave, if that, and we don’t want to spend every spare moment when we’re not at work effing pumping.

NoLongerCrunching

A much scarier scenario to me is a baby who is so lethargic from inadequate calories that he doesn’t scream from hunger, just sleeps all the time to conserve energy. New mothers often don’t even realize that their baby isn’t getting enough food because the baby is not demanding it. These babies experience the most severe weight loss, because as time goes on the mothers milk supply goes down from inadequate stimulation.

I have seen babies who haven’t gained weight for *months.* When that happens, everyone can say goodbye to exclusive breastfeeding for that baby forever, because the mother’s milk supply is extremely unlikely to recover from that. So instead of the baby getting a few 15 mL supplements of formula in the first few days, the baby gets gallons of it over the whole first year of life. Seriously fellow LCs … WTF????

Roadstergal

“I have seen babies who haven’t gained weight for *months.*”

How can this not affect neural development? The brain is incredibly metabolically active. That just sounds so scary.

NoLongerCrunching

It is terrifying. I don’t know what happens to their brains, but I would assume that their body gives up a lot to protect the brain as best it can. These babies have very little subcutaneous fat and don’t appear to have grown much is in size. The vast majority of mothers are of course very happy to start supplementing immediately, but unfortunately I have seen the occasional mother who is just too scared by the “risks of formula” that she is reluctant to do it.

Maybe I should consider drawing up something similar to Dr. Amy’s dead baby card to have them sign, like “My lactation consultant has explained to me the risks of underfeeding my baby, which include poor growth, delayed developmental milestones, and future educational difficulties. I acknowledge these risks and take full responsibility for accepting them on behalf of my baby.” Smh.

Mac Sherbert

Well, like my husband’s granddad was fond of saying “The kid has got to eat something.” Meaning stop worrying so much over what they’re eating and just make sure they are fed because sometimes it’s better to let them have the sugary yogurt than nothing at all. Same thing with breast milk and formula. Kids are growing so fast they need the calories. I hate to hear about people who deny their toddlers food because they have this perfect diet they think the kid needs.

Personally I am just happy for her to eat. She is very reluctant to try new things so I’m hoping she grows out of it.

yentavegan

Exactly! WTF LC’S? I am frustrated with the professional lactation community. They are ignorant of their scope of practice limitations and are more likely to recommend chiropractic interventions and cranio sacral therapy and tongue clipping rather than admitting to the frazzled mother that breastmilk and breastfeeding is not enough. More often than not the answer to the baby’s issue is supplemental feedings. Formula does the body wonders.

Inmara

When I registered with our pediatrician she asked whether I have infant scale at home and will be able to follow baby’s weight gain. She mentioned that their practice has seen babies who have barely returned to birthweight after a month. Scary as hell. Husband’s colleague had a baby recently and borrowed our scale to make sure baby is adequately fed (it was, yay for them and also for men who discuss childrearing and share practical advice!)

Kelly

I think a scale should be standard for those who are breastfeeding.I think it would help people figure out what the problem is quicker.

Yep. That’s what my 2nd one was like in the hospital. Wouldn’t wake up to feed. I requested formula and when the LC got there she confirmed supplementing formula until the baby woke up because it’s a kind of cycle. I can’t imagine going weeks like that. I was upset enough that the first nurses didn’t take my concerns seriously that she wasn’t interested in nursing apparently there’s some time line then they get worried However, my gut just knew it wasn’t going to change without intervention. She wasn’t suddenly going to wake and be like where’s the milk and the LC confirmed it. (Not all LC’s are bad…sad that so many of them seem to be though.)

The Computer Ate My Nym

After small one was born, I got dehydrated and didn’t make enough milk. So small one got dehydrated and spiked a small fever. There was much concern about sepsis and the possibility of her going to the NICU, but then someone considered dehydration as a diagnosis. Then there was much discussion about whether to supplement or not, which I ended by going and getting a bottle of formula and feeding her. My milk came in the next day and after that I could have fed triplets without difficulty, but if she hadn’t gotten that first few ounces, who knows what would have happened? Maybe nothing much, maybe NICU admission and a true cascade of interventions, all for the lack of a single, well timed intervention.

anotheramy

My third was one of those sleepy babies! 🙁 she slept for 5or 6 hours straight the first night home (I did not see that coming!) and 9 hours the second (and possibly the third?) night!!! After that, I learned to set an alarm at night and had a lactation consultant/RN suggest supplementing when she was a week old. She was still very underweight by her 2 week check up, so we upped the supplement and she did well. I’m so glad my LCs encouraged supplementing and she was happily combo fed till 11 months old. I wrote my LCs a note thanking them for giving me “permission” to supplement.

Nicole Beauchamp

My experience at a BFH was completely different. I had a 36 weeker (second kiddo) and while she didn’t need any NICU care (the hospital did have a NICU), my milk wasn’t sufficient to maintain her glucose levels. The nurses (and the peds and the medwife, even the lactation consultant) were all very proactive about formula supplementation. Actually, the way they approached it, it was almost as if they were worried I’d argue. Everyone wanted a stable glucose because no one wanted to keep sticking the baby’s heel for blood. I was even given extra formula to take home.

My problem with the hospital didn’t come up until weeks after…when we got the bill and saw that we were charged $800+/day for the “nursery” – at a hospital which prides itself for their “rooming in.” My daughter did not go to the “nursery” (it was actually in quotation marks on the bill!?) and we had already paid $700+/night on MY hospital bill for the room. We are currently contesting those charges!!!

Tokyobelle

I would love to hear their rationale behind charging you for a nursery that doesn’t exist under BFHI.

Nicole Beauchamp

At first they tried to say it was for various test, which was untrue as each test was listed in the itemized bill (which we had to specifically request). When we pointed that out to the billing department they said, “that’s how it’s done.” We were told they needed written documentation for any contested charges, so we sent a letter and are waiting to hear back. Next step is to notify the insurance company and let them (and their lawyers) deal with it. The moral of the story ALWAYS request the itemized bill!

Susan

This is so interesting! Obviously, the baby is still a patient in the hospital, whether he goes to the nursery or not he is getting care. But the billing terminology needs to catch up. Is the “nursery” a separate charge in some way from the overall nursing care charge? Just curious. I am no billing expert. Thank god for that.

Nicole Beauchamp

I don’t mind paying for her, she was their patient too. But $800+/per day for the “room” when my “room” charge was $100 less (and they fed me substantially more food!). The only care that was provided was an in room bath and vital sign monitoring (other tests – hearing, glucose, blood work charged separately). They did provide diapers, but we did all the diaper changing and feeding (formula was provided and I was nursing too). She required FAR less nursing care than I did. If she had gone to a nursery and had to be feed and changed and cared for, I could see the charge, but we did the care giving!

Bombshellrisa

Is that how they got around the formula? Charging for NICU because that is where the formula came from or some twisted reasoning along that line so the formula would be considered medically necessary.

NoLongerCrunching

Formula does not have to be considered medically necessary; maternal choice is often used as a rationale, at least in my hospital. Insurance still pays for the formula.

Roadstergal

It’s been mentioned before, but every other hospital patient (aside from babies) is just automatically given food as part of, you know, the need to eat during a hospital stay.

Sarah

Yes, but it’s not ageism apparently.

Nicole Beauchamp

I believe that the formula was deemed “medically necessary” and I think that the peds had to write a Rx for it. Though it was weird, it was done with little to no pomp and circumstance. And everyone was very pro supplementation at that point. My only guess is that it’s a shady billing policy…don’t send itemized bills and hope people just pay. They insurance companies pay because, how do they know if the baby was in the nursery or not…they are babies, that sounds like a reasonable charge.

StephanieA

When I had my older son we were charged for a nursery stay even though he never entered the nursery once (not by my choice). It’s very frustrating.

Bombshellrisa

It’s weird because I had my son at a hospital going for the baby friendly designation and from the start (he was born at 35 weeks) they tried to help me with breastfeeding with the preamble “but right now you have to feed him formula, it’s medically necessary”. I heard that every time they came in to check on him. I think you are right, it’s shady billing.

Madtowngirl

Minus the billing issue, I also had a 36 weeker in a BFH, and I wish I had been at yours! My daughter’s glucose levels were plummeting, and the never even offered formula. Donor milk was offered, though.

I got charged for a nonexistent nursery in addition to the charge for my (our) room. It’s a pretty good racket they’ve got going.

swbarnes2

Mine was 36 weeks, and I got the same, two separate LC’s said to supplement, and sounded like they had a spiel all prepared. I rolled my eyes when they said it would help her IQ, but it was nice to know that they weren’t going to be crazy.

Susan

That’s very interesting. I would like to hear how your contesting the charges works out. I have thought that it may come down to that to get moms the “right” again to send the baby to the nursery again if they want to. It does almost seem like fraud to charge for something you don’t provide. Please get back with how this goes.

Susan

Been thinking about this and really, all hospitals have to do it call it “newborn” care instead of nursery. But I still think if the hospital is charging for the care of the infant that parents should have the right to not have to care for the needs of the baby 24/7. I think parents should also have the right to 24/7 rooming in. That was my preference. But I do have an issue with charging parents for newborn care and then hospitals not being set up or staffed to care for babies if a mother wants/needs rest. I actually think mothers shouldn’t have to even “need” a nursery. If they prefer to have the baby in the nursery, and the baby is a paying patient. I think we should be providing that.

Megan

I’m glad you’re contesting the charges. I mentioned this in a previous thread about rooming in as a strategy to combat forced rooming in. After all, if mom is forced to care for the baby with no help, we shouldn’t be paying for help. Frankly, this is the only strategy may hospitals will listen to (lawsuits or contested charges, both a hit to the bottom line).

Suzanne

Random thing about being billed for things you didn’t use:

When my mom went to the hospital with my little brother, he was number 5. Her labors are like mine–takes forever to get to 4 centimeters, but once you hit 5 centimeters the baby will be there within 2 hours, probably less. She knew this, as he was her 5th baby.

Doctor said, “You’re not anywhere near ready to deliver.”
Mom said, “This is my fifth baby, and I know I will deliver soon.”
Doctor: “I’ve delivered thousands of babies and you are not ready to deliver.”

The doctor left the hospital and because this was in the 70s, he wasn’t reachable.

The baby, of course, was born shortly after the doctor left. My father handled the delivery with the nurses assisting.

When they got the bill there was a charge for the delivery from the doctor. My mother called the doctor and said, “No. You weren’t there and you wouldn’t listen to me.”

He dropped the charge.

BeatriceC

Very little gets me as angry as BFHI.

AirPlant

My mother was a total 80s attachment parent. We were breastfed, she coslept with us, she baby-wore with religious devotion, the whole deal.
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I described the BFHI to her and she thought it was barbaric. That tells me pretty much all that I need to know.

Kelly

It is obvious she did all of that because it worked for the family and not because she thinks everyone needs to do that.

AirPlant

It actually a bit more complicated. My mom was pretty spooled up to be the best and smuggest most natural mother ever, but then she had my brother and he kind of ruined all that with his behavioral issues. It is really hard to be mom of the year when your kid is in speech therapy and keeps trying to pick the other kids noses. 🙂

Kelly

That last part made me laugh. Children have a way of humbling even the most smug parents. There are a few that I know that I can’t wait until they have that child that upends their entire smug and crazy schedules/ideas. I feel like a first time mother with my third child. Although I do not think I am the greatest mom ever but I did think that I had a general sense of how to parent my children. She has had very different problems than her two older sisters and I am already starting to stress that she may be slightly developmentally behind. I feel irrationally that I may be the cause to her problems because of a very bad sickness and the immense amount of stress I was under during her pregnancy.

Who?

You didn’t cause her problems-if they are problems. She’s lucky to have a mum who cares and is keeping an eye on her.

Wendy Dwyer

Just delivered my sixth, a 36 weeker, this little one is doing great, but needs extra care. If she were my first, I shudder to think what damage would be done by such initiative. My milk never comes in before the 3rd day and this baby didn’t have brown fat stores to wait. I am pumping and feeding on a schedule with great success, but that is due to experience, not nature. We didn’t hesitate to supplement with formula from her first feed on. It is why her blood sugars and jaundice numbers shifted so quickly and so well. I don’t need the exclusive bf badge, but I do need the healthy baby one! I just want the guilt gone so I am now committed to being more vocal about my birth choices instead of feeling ashamed of what I know in my heart were educated and good choices for my baby, not a merit badge! Thank you for this forum to finally hear some sense in the midst of madness.

demodocus

congrats!

cookiebaker

Congratulations!

Sean Jungian

Good for you, doing what’s right for your baby and you! And congratulations!

guest

You hit the nail on the head Dr. Tuteur! Most of the hospitals in our area are now going “Baby Friendly”, including ours! It’s ridiculous! It’s torture for the mothers, babies, nurses, and doctors! We as nurses, have no say! Our managers have no say! And the doctors really have no say either, I don’t believe! It’s coming down from upper administration, who has no idea what the initiative really is. They’re buying the crazy lactivists’ claims that it will increase breastfeeding rates. Look at breastfeeding rates of actual “Baby Friendly” hospitals, they’re not any better! I’ve heard horror stories of management threatening the jobs of nurses in other “Baby Friendly” hospitals if they don’t conform to this nonsense. “Baby Friendly” sounds good until the patients actually experience the true hell of “Baby Friendly”! As nurses, we live the hell everyday, and can’t do anything about it! I fear until patients start complaining and threatening to go to other hospitals that don’t act in this ridiculous manner, “Baby Friendly” will be here to stay. Or until hospitals start realizing that these poor babies are being readmitted to the peds units. I hope a baby isn’t seriously hurt by this nonsense! Nurses DO NOT agree with “Baby Friendly”! Yes, we absolutely support breastfeeding! But, we’re not into breastfeeding no matter what the cost to the mom and infant! We’re not into torture! And neither are our pediatricians! “Baby Friendly” makes us ALL look bad! Lactation Consultants are not responsible for an infant’s well-being. They don’t give a crap if the baby’s blood sugar drops, the baby ends up under bili lights, ends up in NICU, or is readmitted. They only have a one track mind, breastfeeding! Nurses and doctors care about the conplete health and well-being of the mother and baby! This is all insanity!!!!

MaineJen

Do you happen to know the actual rate of readmission? It’s good to have numbers to throw back when policy makers start blathering about “cost savings.”

KeeperOfTheBooks

Here’s the thing: readmission means more cash for the hospital, albeit less for the insurance companies. It would be freaking HILARIOUS if the insurance companies end up being frontrunners in the fight against the BFHI because of this.

guest

We just started our BF journey. So, I don’t think readmission has been a big issue yet. But, I’m interested in knowing if BF hospitals have higher readmission rates. Or perhaps the moms are realizing when they need to supplement once they go home and don’t have these crazy LCs interfering! I would love to know if readmission rates are up at BF hospitals. But I can tell you that the minute our LCs started guilting our moms into keeping their babies 24/7, falls went up. And other hospitals have seen the same thing happen! If I can convince a completely exhausted mom to send her infant to the nursery between feedings, I will. Some of these poor moms are falling asleep while you’re talking to them. There are those moms who want to room in 24/7, which is fine as long as the infant doesn’t fall. Hopefully they have a helpful, and not as exhausted support person staying with them!

AA

I wonder if hospital safety teams specializing in fall prevention have been ignoring L&D units in favor of of what we typically think of as high risk fall units, such as the ICU. Is a fall report completed for every time a baby nearly falls out of a parent’s arms or the bed? A lot of hospitals classify a reportable fall as even a “unplanned descent” or requiring staff to report “near miss falls.” A rising rate of fall reports catches the eye of the fall monitoring group and perhaps will draw attention to the dangers of “Practice rooming in”

amy

At my hospital (classified baby friendly) every mom I saw was classified as a fall risk (with an arm band and everything) and I was given specific instructions on how to not fall/drop the baby. I was told not to carry the baby, but put him in the bassinet and push it around. Not sure if that’s what you’re asking, but that was the case for me.

guest

Infant drops are definitely going up because of the BFHI. Most hospitals that are going for BFHI are seeing this! Yet ANOTHER reason why nurses and docs hate BFHI. It doesn’t matter how much education you give an exhausted mom about how to “not drop baby”…put baby in the crib when you’re getting sleepy, don’t sleep with baby, etc. If you have an exhausted mom that’s constantly breastfeeding (because this is what our LC’s tell them to do to bring enough milk in), it takes one second to nod off to sleep unintentionally and drop the baby! This ALONE should stop this BFHI madness, but somehow it hasn’t. With the falls that occurred at our hospital, luckily the babies were fine! This is why our nurses refuse to make everyone room in. We still have a nursery available at this point! And our moms WANT the nursery! At some point, we’ll be forced to make them room in when it gets closer to our BF evaluation. But, it’s completely ridiculous! Dropping your baby is a huge risk of rooming in when you’re exhausted from labor. That completely erases all other benefits of rooming in in our book! Mom and baby will still bond just fine even if mom uses the nursery. And she’ll even be able to breastfeed. So these other hospitals are seeing similar increases in infant drops. I do think pediatricians need to take a stand against BFHI. They have more power than nurses. But there are also enough nipple nazi patients out there who are breastfeeding crazy and judge women who don’t breastfeed that I think docs are afraid of patients thinking that they’re anti-breastfeeding! Hospitals don’t benefit from infants being readmitted to peds for when breastfeeding doesn’t work either. Believe me, there are already enough sick kids on peds. This is why we can’t understand why hospitals aren’t taking a stand against BFHI. It’s being enforced by upper administrators who have no medical background. And they’re listening to these crazy lactivists. Until the infant falls problem and infants being dehydrated, loosing too much weight, becoming jaundice, and needing to be readmitted becomes bad enough that administrators are saying, “what the hell is going on here?”, I think BF designation will continue to be pursued. There are PLENTY of people in favor of it, mainly lacticists and women who had no trouble breastfeeding, and love to judge others. The rest of use don’t care how you feed your baby as long as you’re feeding the baby. But I think the bad aspects of BF need to prove themselves before the madness stops unfortunately! I can’t believe it got this far in our country, but it did! It’s unbelievable to the nurses who have to deal with this! We do see plenty of women who refuse formula when medically necessary. So there are people who love the BFHI and believe in it. And these people don’t understand how dangerous the BFHI is. Our administrators are included in not understanding that it’s dangerous, and they’re calling the shots. Many LCs aren’t even nurses anymore, which is ridiculous. So they have no other job but to push breastfeeding. And they may sound like they know what they’re talking about. But, I guarantee that they’ve never taken care of a sick infant!

Taysha

I remember when my son had a borderline low blood sugar the nurse ran to my room and asked me if it was ok to give him some formula, just to make sure he didn’t go lower.

the look of relief on her face when I enthusiastically agreed (“Give him anything he’ll take!” I believe was my response) was confusing at the time. It makes sense now.

The boy’s blood sugar stabilized and he was happily discharged on time with no problems.

Tokyobelle

Same situation here, only it was the Ped who suggested it. I didn’t know that starving my baby was a real possibility, only that he was hungry and I generally don’t think of myself as a monster, so I was not interested in starving my baby. I shudder to think that if I had been more militant about BF, I could have caused real damage.

Heidi

I experienced a similar situation. Baby was born with a little bit of a low blood sugar. Since I was planning to breastfeed, I experienced over a day of having my breasts squeezed by nurses into spoons, latching the baby, fighting him to stay awake, but nothing was getting his sugar up high enough. Then the pediatrician comes in, lecturing us about how we need to give him formula, otherwise he’ll end up in the NICU with an IV. I never opposed formula! She’d already had it in her mind we were opposed to formula, she was giving the speech. But I tried not to take too much offense, since I imagine she’s encountered opposition so many times.

KeeperOfTheBooks

While even I’m not *quite* cynical enough to say cause and effect here, it is worth bearing in mind that the hospital does make more money if the kid gets readmitted later for jaundice/nicu stay/dehydration/et all.

Eater of Worlds

I don’t know how many babies are actually covered under Medicare, but if the person gets readmitted within 30 days the hospital is fined. Half the hospitals in the US were fined in 2015. So hospitals definitely can lose money from readmitting.

Almost no infants are covered under Medicare because of the health issues required for those under the age of 65. I know when I had a client with kidney failure who was pregnant (and on Medicare), we had to get Medicaid lined up to cover the baby once it was was born.

Eater of Worlds

I figured as much, but it does show that hospitals are dinged financially for readmittance issues.

Megan

I believe it is a JCAHO quality measure so even if the patient is not Medicare, the hospital still gets monitored for readmissions.

MI Dawn

That, I believe is correct, Megan. Also (as I work for one), I can say that insurance companies *really, really, really* don’t like re-admissions of any kind. Especially infants.

The Computer Ate My Nym

The problem is that hospitals get into trouble for readmissions and for having lengths of stay that are longer than those set by the insurance company as how long a person with a given condition is supposed to be in the hospital. Which kind of screws things up for anyone who has a complication: There is pressure to toss them out before they’re ready and to avoid readmitting them if they present to the ER having gotten worse at home.

CSN0116

My friends, family, and acquaintances ask ALL THE TIME why my babies sleep so well. Indeed, from birth, I only feed in 4-hour intervals during the day and allow the babies to dictate the intervals at night (often 5-6 hour stretches). I exclusively formula feed. By 6-8 weeks of age all five have been sleeping 12 hour uninterrupted overnights and feeding four hours all day (and taking several naps). I’ve had pre-term and post-term infants who all fall into the same description.

Every time they ask about the “miraculous” sleep I’m somehow able to achieve, I tell them it’s because a full baby will sleep. A hungry baby, or even a slightly nutritionally unsatisfied baby, struggles to truly rest.

I see them get into cycles where baby is fed, but not as much as they want/need; then mom tries to get a “still hungry” baby to nap, but baby is longing for more food, so she’s restless. Baby fusses and fights sleep. Mom naturally tends to the baby over and over and over, unintentionally reinforcing poor sleep habits that could have never really started in the first place had it been for just letting the baby eat more. BAM, you have a poor sleeper. “Fill em’ up” is always my advice. I let my babies eat as much as they want and increase the amounts when I see them readily finishing a given amount several times in a row. And I sure as hell don’t cut them off at “X” ounces. A nurse showed me that my baby’s stomach was only the size of a bead in the hospital once; I went on to feed him 2 oz of formula just minutes after birth 😛

Elisabetta Aurora

This was my same realization. With mine, it occurred to me pretty quickly that she just wasn’t getting enough. Poor weight gain, super fussy. I started supplementing with no schedule. I nursed her until it seemed like that was all there was and then I “topped her off” with formula. She learned to sleep through the night on her own by 8 weeks. By that time, my milk production had caught up with her needs and I was able to feed her less and less formula so that by about 8 weeks she was exclusively breast fed.

I suspect that the inability to sleep through the night by three months is likely due to a.) a lack of milk and/or b.) entering day-care right away and being exposed to lots of other kids’s germs and being chronically sick. But, it seems that nobody ever talks about either of those possibilities.

FYI, I’m due in June with my second and just bought a set of bottles. I’ll be exclusively formula feeding this time and I’m quite excited about it!

demodocus

Congrats; my 2nd’s due in June too 🙂

Inmara

My go-to book for sleep, “Healthy Sleep Habits, Happy Child” disagrees re: sleeping through the night and sufficient feeding. Of course, hungry baby won’t sleep for long, but having ample supply/feeding formula is not a guarantee that baby will sleep through the night. Case in point, we started giving a bottle of formula before bed at 2 months, yet baby still had 2-3 night feeds which slow-faded to 1 at about 5-6 months and finally to none at 7,5 months. And mine is a good sleeper overall! I don’t think that our first weeks with inadequate supply did that to his sleep, he was colicky for about 6 weeks too and then it was quite smooth sailing even with some typical sleep regressions. Other example, husband’s ex-wife – her first was not sleeping through the night until 10 months until he weaned (and he gained weight like a champ, so no hunger there!); her second was sleeping 6-7 hour stretches already at 1 month. My SIL had ample supply yet her youngest was feeding every 2 hours day and night for 20 months (then BIL got fed up, kicked her out from bedroom and kid started to sleep through the night almost immediately). So it’s a combination of sleep patterns and sleeping routines rather than feeding method (yet I wholeheartedly agree that insufficient supply should be evaluated if baby is waking up and feeding often).

Megan

Can you get my EFF 5 week old to sleep more than 3 hours then? I do the same thing and it makes no difference. I’d love to be getting a full nights sleep or even wake only once! Was your experience the same with your reflux baby?

CSN0116

My reflux baby was fussier and less able to rest until we figured out what was up. The previous three never displayed these symptoms so it took me a couple weeks to even catch on. So, he would feed until he was full (and I knew he was full) but never be able to let loose, relax, and truly rest. If it wasn’t hunger, then I knew it was *something* else. By week three he started with outward symptoms – projectile vomiting after feeds. That, coupled with the “fussy” evidence of the weeks prior convinced me it was reflux. His doctor agreed.

AS SOON as we started thickening his formula (and sleeping him inclined on his belly) he guzzled it, went limp, and slept like he was longing to sleep for YEARS. He also stopped vomiting. He was suddenly the content, able-to-rest baby that I was used to seeing in his three sisters before him. And that happened around 3-4 weeks of age. Over the next month he started eating larger feeds throughout the day, which decreased his need for nutrition at night, and he slept through at about 8 weeks.

We hired an infant sleep specialist to work with us from birth after our firsts were born (twins). We didn’t want to dick around and wanted good sleepers from day one, and we didn’t know shit about how to achieve it. We took what she taught us – because it’s amazing advice! – and applied it to all of the other kids. I mean this woman makes a fucking fortune telling people to do THE SAME THINGS over and over. She uses the same regimen with every baby she works with and she is booked SOLID. Literally when women piss positive on a stick they call her.

Her “rules” basically go like this: never feed to sleep; never rock to sleep; never replace a binky 10x to get a baby to sleep; do not hold a sleeping baby for very long (place them down for sleep); follow the wake, feed, play, sleep routine; baby sleeps in its own space (preferably its own room) from birth; baby naps and sleeps overnights all in the same place; shade the sleep space somewhat during the day; use white noise; wake to feed during the day (if need be), but never wake a full-term/otherwise healthy baby at night to feed; all overnight feeds are done in the dark with zero interaction with baby; always put baby down drowsy and allow them to drift off; allow them to “fuss-it-out” for a few minutes before going to them. She was also a big fan of the “bath, bottle/breast, bed” routine.

Megan

I do a lot of those things because I learne the hard way about creating bad sleep habits with my first. They were hard to break! Anyway, we are off to a much much better start this time around. Since we started having current baby sleep in the swing, she is sleeping one 4 hour stretch at night, and the swing doesn’t even need to be on, so I do think it’s about the incline (and probably about feeling snug too). I think we are starting Zantac soon though. I had wanted to give the formula switch a fair shake before trying meds and while it did improve things a lot, she’s still suffering. I hope that, coupled with getting a bit older, will help lengthen her sleep at night. The only good news with the reflux is that she doesn’t eat much at night and tends to tank up during the day, so hopefully that will help her sleep I truly don’t mind waking at night, but it’d be nice if it could be just once now that she’s nearing the 6 week mark.

demodocus

Good luck! my first actually did have a single sleep through the night at around 8 weeks, then went back to normal for a while. On Christmas night, no less. Best present of the year

Clorinda

My oldest and youngest (youngest is about 2) both had feeding and sleeping issues. My youngest had weight gain issues but just barely not enough to be considered FTT. After reading these blogs and comments for a while, I’ve come to the realization that we were probably pretty darn lucky that there wasn’t malnutrition going on with them. And I’m also realizing that while we didn’t seek out the woo, it still managed to infiltrate our thinking to some extent. I WISH I had supplemented. I wish I had had the knowledge to supplement. Life would have been much easier, and with those two, I would have gotten more sleep and been a better mom during the tiring feeding months. I can blame some of the experience with my first on being a first time mom. My other kids slept and ate just fine for the most part, and that lulled my into thinking my last kid would be the same. But in the mean time, my health had changed and having more kids to take care of didn’t help anything. For my last one, I probably produced enough to prevent malnutrition but not enough to make an entirely happy and well rested baby.

Suzannne

Eh, genetics. My EBF baby used to take a 4 hour nap every afternoon, until she was two. I worked PT from home and people were always asking how on earth I put in 20 hours of technical work (I did a lot of Access programming) and data analysis while tending to a baby. I said, “well, I work when she naps!” I assumed a 4 hour afternoon nap was normal.

It was normal. For my baby. Good sleeping is normal for your babies. Yes, a well fed baby sleeps better than a hungry baby, but lots of well fed babies don’t sleep. My little brother, for instance, who was a roly poly chub ball but was such a screamer and awful sleeper that my mother declared if he was the first baby, he would have been an only.

And that rotten little baby grew up to be a delightful adult, But, he now has 5 kids, two of which inherited Dad’s sleeping and screaming habits. My SIL is a SAHM and we tell her it’s not fair that she’s suffering for the grandma curse placed on her husband.

demodocus

it took 5 days for my milk to come in. once it did, it really did, but I’m sure my kiddo was very glad that the nice nurse at our gps’ told us to go pick up some formula in the interrim.

fiftyfifty1

Nurses and doctors are muzzled; they can’t counsel her about formula supplementation until the baby is seriously ill. All the while her baby is suffering.”
No. We aren’t muzzled. We can still counsel our patients. It’s our ethical duty to speak up and advocate for our patients. We docs have gotten too passive and have let others make clinical “rules” too often. We (docs that is, much less so nurses) are in a position of power. They can reprimand us, but what are they going to do? Fire us all?

BeatriceC

Doctors are probably less affected than nurses. You have far more autonomy and also see the patients once they leave the hospital. Nurses are held to metrics frequently out of their control, and often times fear enough for their jobs that they just go along with things even if they don’t agree. I can easily see this as very similar to what’s happening with the US educational system. We teachers KNOW that the various dictates coming down are not just ineffective, but detrimental, but we’re at a loss to do anything about it. Some teachers, like me, quit and don’t come back. The remaining teachers are fed the party line that we “just couldn’t hack it”. Truth be told, I could hack it, and then some, but what I couldn’t deal with is actively hurting the kids I was supposed to be teaching. I had the ability to move into a different field (and then leave the workforce entirely), so I did. Many teachers don’t have that ability. I’m assuming something similar is happening with nurses.

In these comments sections we’ve had a couple nurses and on LC talk about how the breastfeeding rates of mothers directly impact their employment. They get dinged in performance reviews, which means their salaries and even their jobs can be affected by something that’s almost 100% out of their control. So they’re forced to say and do things they don’t want to do, just to keep their jobs. If they quit or go to a different department, there’s always a young nurse to take their jobs (like there’s always a young teacher to take the place of the experienced teachers that actually are quitting), but then the quality of care goes down because those young nurses don’t know any different, and if they haven’t had kids of their own, they don’t have the life experience to realize that something is very, very wrong.

demodocus

oh, my, some of the kids i was having teaching courses with. I’m 15 years their senior and i might have had the same level of teaching experience, but dang, a few of them really reminded me why I’m glad to be in my 30s, and not 20.
My favorite story was the one who’d *just* turned 21 who actually said, in all seriousness “back in my day, *we* didn’t dress so sluttily” Um, yes, honey, you did.

AirPlant

Back in my day? Like last year? Am I am old now, because I am pretty sure that 21 is still considered “in your day”

demodocus

I know, right?!? Every person I’ve told over 30 just laughs.

BeatriceC

MrC and I sometimes get in amusing discussions about “back in my day”. He’s 22 years my senior (I like my men vintage, what can I say?), so his day and my day are two very different things.

fiftyfifty1

Yes. Nurses are in a potentially vulnerable position. But doctors really aren’t. This is why it is up to us to push back.

Kelly

I was thinking the same thing as a former teacher.

AA

I think more peds need to get on board with the chorus of angry voices. Maybe their opinions are being ignored because although they are rounding on babies that are rooming in, they’re not in the peds wards so fall reports do not fall under peds stats on fall rates. Hospitals DESPISE having a high fall rate. Time for some peds to get grants from their departments or other funding sources and do research on fall rates.

NoLongerCrunching

Pediatricians may not be muzzled, but in this climate many are afraid of being seen as unsupportive of breastfeeding. Christie del Castillo-Hegyi’s pediatrician was apparently so afraid of this that he let her baby get to FIFTEEN percent weight loss, with severe and permanent consequences to her son’s brain.

Erin

The French pediatrician caring for my son in NICU on learning how triggering I found breastfeeding told me to stop, her boss overheard, told her off and told me that I would regret giving up as my milk was in. I carried on and it was a mistake.

Amy Tuteur, MD

Dr. Amy Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College in 1979 and her medical degree from Boston University School of Medicine in 1984. Dr. Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. Her book, Push Back: Guilt in the Age of Natural Parenting (HarperCollins) was published in 2016. She can be reached at DrAmy5 at aol dot com...
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